Individual
MR. JESSE ANTHONY BONILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP-BC
Contact information
Practice address
2112 E 4TH ST STE 228A, SANTA ANA, CA 92705-3840
(714) 420-9890
(949) 749-7433
Mailing address
2112 E 4TH ST STE 228, SANTA ANA, CA 92705-3840
(714) 420-9890
(949) 749-7433
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95028137
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
CB540002
—
CA
Enumeration date
11/29/2023
Last updated
12/08/2025
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