Provider Demographics
NPI:1720656358
Name:BONILLA, REYNA CRISTINA (ACSW)
Entity type:Individual
Prefix:MRS
First Name:REYNA
Middle Name:CRISTINA
Last Name:BONILLA
Suffix:
Gender:
Credentials:ACSW
Other - Prefix:
Other - First Name:REYNA
Other - Middle Name:CRISTINA
Other - Last Name:HERRERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2445 W WHITES BRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706-1225
Mailing Address - Country:US
Mailing Address - Phone:559-264-5096
Mailing Address - Fax:
Practice Address - Street 1:171 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93701-1671
Practice Address - Country:US
Practice Address - Phone:559-428-3052
Practice Address - Fax:559-465-8052
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2025-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA123796104100000X, 101YM0800X
171M00000X
CAMPSS-FWDSJV175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No175T00000XOther Service ProvidersPeer Specialist