1376633487 NPI number — MRS. JOY BONIFACIO LOCKWOOD DDS

Table of content: MRS. JOY BONIFACIO LOCKWOOD DDS (NPI 1376633487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376633487 NPI number — MRS. JOY BONIFACIO LOCKWOOD DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOCKWOOD
Provider First Name:
JOY
Provider Middle Name:
BONIFACIO
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:
BONIFACIO
Provider Other First Name:
JOY
Provider Other Middle Name:
REMIGIO
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376633487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8590 RIO SAN DIEGO DR
Provider Second Line Business Mailing Address:
#110
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-299-1122
Provider Business Mailing Address Fax Number:
619-299-1163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8590 RIO SAN DIEGO DR
Provider Second Line Business Practice Location Address:
#110
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-299-1122
Provider Business Practice Location Address Fax Number:
619-299-1163
Provider Enumeration Date:
10/13/2006

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: 1223G0001X , with the licence number:  50126 , 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)





Copyright © 2007-2025 www.npivalidator.com