Provider Demographics
NPI:1992862064
Name:TAUBER, BONNIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:TAUBER
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2147 RONDA GRANADA UNIT B
Mailing Address - Street 2:
Mailing Address - City:LAGUNA WOODS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-0719
Mailing Address - Country:US
Mailing Address - Phone:310-876-9600
Mailing Address - Fax:
Practice Address - Street 1:2147 RONDA GRANADA UNIT B
Practice Address - Street 2:
Practice Address - City:LAGUNA WOODS
Practice Address - State:CA
Practice Address - Zip Code:92637-0719
Practice Address - Country:US
Practice Address - Phone:310-876-9600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 17093103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist