Judith Anallely Bonilla Lopez

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

63986 Issued in CA

Practice address

17216 Slover Ave
Fontana, CA 92337-7580

Phone

(909) 854-3431

Fax

(909) 428-8437

NPI assigned

Dec 14, 2016

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1481673600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482796800000",
    "number": "1972047645",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17216 SLOVER AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377580",
            "telephone_number": "909-854-3431"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17216 SLOVER AVE",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923377580",
            "telephone_number": "909-854-3431",
            "fax_number": "909-428-8437"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONILLA LOPEZ",
        "first_name": "JUDITH",
        "middle_name": "ANALLELY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-12-14",
        "last_updated": "2016-12-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "CA",
            "license": "63986",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Mental Health Counselor in Fontana, CA
• Providers in Fontana, CA by specialty
• Mental Health Counselor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.