Provider Demographics
NPI:1962940379
Name:GARCIA, BONNIE
Entity type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:GARCIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 S MONTEBELLO BLVD APT C
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-5141
Mailing Address - Country:US
Mailing Address - Phone:323-605-7407
Mailing Address - Fax:
Practice Address - Street 1:441 S MONTEBELLO BLVD APT C
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-5141
Practice Address - Country:US
Practice Address - Phone:323-605-7407
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2017-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63527126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant