Neurodivergent Psychiatric Specialists
NPI 1417848219ActiveOrganization· Internal Medicine· Santa Ana, CA
Internal Medicine in Santa Ana, California, registered in NPPES in July 2025. The authorized official on file is Jesse Anthony Bonilla, PMHNP, Executive Officer. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1417848219 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Jul 10, 2025 |
| Last updated in NPPES | Dec 8, 2025 |
| Certified by provider | Dec 8, 2025 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Internal Medicine Primary | 207R00000X | — | — |
| Psychiatry & Neurology, Psychiatry | 2084P0800X | — | — |
| General Practice | 208D00000X | — | — |
| Nurse Practitioner, Psych/Mental Health | 363LP0808X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (CA) |
|---|
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