Individual
TERESA BONILLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SUPPORT SPECIALIST
Contact information
Practice address
590 W 8TH ST, SAN PEDRO, CA 90731-3120
(310) 831-2358
Mailing address
590 W 8TH ST, SAN PEDRO, CA 90731-3120
(310) 831-2358
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
MPSS-WTVSYE
CA
Other
Enumeration date
06/17/2025
Last updated
06/17/2025
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