Provider Demographics
NPI:1316918857
Name:KNEIBLER, BONNIE (MD)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:KNEIBLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8465 OLD REDWOOD HWY
Mailing Address - Street 2:STE 320
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8090
Mailing Address - Country:US
Mailing Address - Phone:707-838-6685
Mailing Address - Fax:707-838-6686
Practice Address - Street 1:8465 OLD REDWOOD HWY
Practice Address - Street 2:STE 320
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492
Practice Address - Country:US
Practice Address - Phone:707-838-6685
Practice Address - Fax:707-838-6686
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50636207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G506360Medicaid
CA00G506360Medicaid
00G506362Medicare ID - Type Unspecified