Individual
JOHANIS BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
622 W 168TH ST, NEW YORK, NY 10032-3720
(877) 426-5637
Mailing address
63 N 5TH AVE, LONG BRANCH, NJ 07740-6902
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
NJ
390200000X
Student in an Organized Health Care Education/Training Program
—
PA
Other
Enumeration date
01/23/2023
Last updated
10/07/2024
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