Provider Demographics
NPI:1194713925
Name:BONZANI, TERESA ANN (MD)
Entity type:Individual
Prefix:DR
First Name:TERESA
Middle Name:ANN
Last Name:BONZANI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:TERESA
Other - Middle Name:
Other - Last Name:KAMMERER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:
Mailing Address - City:TRAVIS AFB
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-423-3826
Mailing Address - Fax:
Practice Address - Street 1:60 MDOS/SGOE
Practice Address - Street 2:101 BODIN CIR
Practice Address - City:TRAVIS AFB
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:707-423-3826
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87853207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI21160Medicare UPIN
CA00A878530Medicare ID - Type Unspecified