Provider Demographics
NPI:1689929895
Name:BONILLA, VINCENT (LMFT)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:BONILLA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 93129
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91109-3129
Mailing Address - Country:US
Mailing Address - Phone:818-305-0931
Mailing Address - Fax:
Practice Address - Street 1:8050 FLORENCE AVE STE 32
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90240-3896
Practice Address - Country:US
Practice Address - Phone:818-305-0931
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-13
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51543106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist