Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | A66385 | CA |
N | 208800000X | Urologist | A66385 | CA |
NPI | 1104859164 |
---|---|
Provider Name | Aram Bonni |
First Address | Mission Viejo, CA 92692-3263 |
Second Address | Santa Ana, CA 92701-5302 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 24/09/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A66385 | CA STATE MED LICENSE (01) | CA |
G82695 | (02) | CA |