Active NPI
Michael Bonilla
- Case Manager/Care Coordinator
- Pacoima, CA
National Provider Identifier
1992478630
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393 - Phone
- (818) 896-1161
- Fax
- (818) 896-5069
- NPI assigned
- Jul 28, 2021
- Last updated
- Dec 20, 2022
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Case Manager/Care Coordinator | 171M00000X | Primary | ||
| Behavior Technician | 106S00000X |
Addresses
Primary practice location
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Mailing address
12450 Van Nuys Blvd Ste 200
Pacoima, CA 91331-1393
Phone (818) 896-1161
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7420 | Medicaid | CA | |
| 6758 | Medicaid | CA | |
| 7068 | Medicaid | CA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mebe Los Angeles LLC | Behavior Technician | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627430400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1671494400000",
"number": "1992478630",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161",
"fax_number": "818-896-5069"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12450 VAN NUYS BLVD STE 200",
"city": "PACOIMA",
"state": "CA",
"postal_code": "913311393",
"telephone_number": "818-896-1161",
"fax_number": "818-896-5069"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONILLA",
"first_name": "MICHAEL",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-28",
"last_updated": "2022-12-20",
"certification_date": "2022-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7420",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6758",
"state": "CA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "7068",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Pacoima, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.