Organization Name: | BONITA SURGICAL MEDICAL CENTER |
NPI Number: | 1144574815 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ALEXANDER SOROKURS (MEDICAL DIRECTOR) |
Mailing Address: | 221 N San Dimas Ave Ste 200 San Dimas |
State: | CA US |
Postal Code: | 917732664 |
Phone Number: | 9095920142 |
Fax Number: | 9095920339 |
NPI Enumeration Date: | 11/02/2012 |
NPI Last Update Date: | 11/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QA1903X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Ambulatory Surgical |
Taxonomy Definition: |