Provider Demographics
NPI:1003270539
Name:BONA FIDE SURGICAL ASSISTANCE
Entity Type:Organization
Organization Name:BONA FIDE SURGICAL ASSISTANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:DUQUE
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:909-294-7329
Mailing Address - Street 1:310 N INDIAN HILL BLVD STE 526
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-294-7329
Mailing Address - Fax:909-912-8631
Practice Address - Street 1:274 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723
Practice Address - Country:US
Practice Address - Phone:909-294-7329
Practice Address - Fax:909-912-8631
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-11
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17201363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty