Provider Demographics
NPI:1225551955
Name:BONILLA, ANNY (BEHAVIOR TECHNICAN)
Entity type:Individual
Prefix:
First Name:ANNY
Middle Name:
Last Name:BONILLA
Suffix:
Gender:F
Credentials:BEHAVIOR TECHNICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 HOOWAIWAI LOOP APT 2606
Mailing Address - Street 2:
Mailing Address - City:WAILUKU
Mailing Address - State:HI
Mailing Address - Zip Code:96793-4132
Mailing Address - Country:US
Mailing Address - Phone:808-276-2417
Mailing Address - Fax:808-442-9816
Practice Address - Street 1:139 HOOWAIWAI LOOP APT 2606
Practice Address - Street 2:
Practice Address - City:WAILUKU
Practice Address - State:HI
Practice Address - Zip Code:96793-4132
Practice Address - Country:US
Practice Address - Phone:808-276-2417
Practice Address - Fax:808-442-9816
Is Sole Proprietor?:No
Enumeration Date:2017-07-25
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRBT-17-36195106S00000X
HIBA539103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIBA-539OtherBEHAVIOR ANALYST LICENSE