1447362546 NPI number — MRS. CLAIRE AMBER BONGIOVANNI MA

Table of content: MRS. CLAIRE AMBER BONGIOVANNI MA (NPI 1447362546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447362546 NPI number — MRS. CLAIRE AMBER BONGIOVANNI MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BONGIOVANNI
Provider First Name:
CLAIRE
Provider Middle Name:
AMBER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SOITHONG
Provider Other First Name:
CLAIRE
Provider Other Middle Name:
AMBER
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1447362546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2245 W BROADWAY APT N207
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANAHEIM
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92804-1320
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-309-9022
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
111 N LA BREA AVE
Provider Second Line Business Practice Location Address:
7TH FLOOR
Provider Business Practice Location Address City Name:
INGLEWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90301-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-855-0031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/31/2006

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: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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