Provider Demographics
NPI:1063007870
Name:BONI, GINA
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:
Last Name:BONI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 E AVENUE I STE 101
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93535-1941
Mailing Address - Country:US
Mailing Address - Phone:714-873-0860
Mailing Address - Fax:
Practice Address - Street 1:340 E AVENUE I STE 101
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93535-1941
Practice Address - Country:US
Practice Address - Phone:714-873-0860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-03
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst