Individual
RODOLFO STEVEN BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSW
Contact information
Practice address
750 ROUND VALLEY DR, PARK CITY, UT 84060-7548
(435) 655-0926
Mailing address
2252 SAMUEL COLT CT, PARK CITY, UT 84060-7423
(801) 243-6933
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
11275783-3502
UT
Other
Enumeration date
07/09/2020
Last updated
07/09/2020
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