1225116460 NPI number — MRS. CLAUDIA RENDON BONILLA DDS

Table of content: MRS. CLAUDIA RENDON BONILLA DDS (NPI 1225116460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225116460 NPI number — MRS. CLAUDIA RENDON BONILLA DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RENDON BONILLA
Provider First Name:
CLAUDIA
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225116460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 PARISVILLE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALISO VIEJO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-916-1224
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30021 ALICIA PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAGUNA NIGUEL
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92677-2090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-363-5880
Provider Business Practice Location Address Fax Number:
949-363-5875
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  44994 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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