Individual
EVELYN BONILLA LINE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S., CCC-SLP
Contact information
Practice address
7812 EDINGER AVE #400, HUNTINGTON BEACH, CA 92647
(714) 916-0641
Mailing address
605 LAKEVIEW LN, COSTA MESA, CA 92626-3132
(714) 651-1264
(714) 651-1264
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SP28033
CA
Other
Enumeration date
07/08/2013
Last updated
07/01/2020
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