Basic Information
| Provider Information | |||||||||
| NPI: | 1669019618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONILLA-ROJAS | ||||||||
| FirstName: | ALEJANDRA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 516 W ATEN RD STE 2 | ||||||||
| Address2: | |||||||||
| City: | IMPERIAL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922519805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603557730 | ||||||||
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| Practice Location | |||||||||
| Address1: | 751 W LEGION RD STE 102 | ||||||||
| Address2: | |||||||||
| City: | BRAWLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922277754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603518696 | ||||||||
| FaxNumber: | 7605450253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2019 | ||||||||
| LastUpdateDate: | 12/09/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/09/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95013421 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 95013421 | 01 | CA | FNP LICENSE | OTHER | 95013421 | 01 | CA | FURNISHING LICENSE | OTHER |