Provider Demographics
NPI:1972148377
Name:YI, VICTORIA BONIFACIO
Entity type:Individual
Prefix:MRS
First Name:VICTORIA
Middle Name:BONIFACIO
Last Name:YI
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 1:3345 OAKHURST AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-2827
Mailing Address - Country:US
Mailing Address - Phone:909-996-0678
Mailing Address - Fax:
Practice Address - Street 1:440 N MOUNTAIN AVE STE 103
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-5183
Practice Address - Country:US
Practice Address - Phone:805-719-3700
Practice Address - Fax:805-413-9099
Is Sole Proprietor?:No
Enumeration Date:2019-11-10
Last Update Date:2022-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012826363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner