Provider Demographics
NPI:1104202829
Name:BONILLA PADILLA, JOSE ALBERTO (AMFT 138707)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:ALBERTO
Last Name:BONILLA PADILLA
Suffix:
Gender:M
Credentials:AMFT 138707
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:ALBERTO
Other - Last Name:BONILLA PADILLA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:AMFT138707
Mailing Address - Street 1:540 S EREMLAND DR
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-3186
Mailing Address - Country:US
Mailing Address - Phone:626-966-1577
Mailing Address - Fax:
Practice Address - Street 1:540 S EREMLAND DR
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3186
Practice Address - Country:US
Practice Address - Phone:626-966-1577
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-04
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist