Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95005936 | CA |
NPI | 1003354903 |
---|---|
Provider Name | Bonnie Ridge |
First Address | Oxnard, CA 93033-5310 |
Second Address | Oxnard, CA 93033-5310 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2017 |
Last Update Date | 10/02/2017 |