Provider Demographics
NPI:1083867683
Name:ROBLES-BONHAM, SANDRA (PA)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:
Last Name:ROBLES-BONHAM
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 W. MARCH LANE
Mailing Address - Street 2:SUITE A
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5723
Mailing Address - Country:US
Mailing Address - Phone:209-477-5552
Mailing Address - Fax:209-477-5553
Practice Address - Street 1:77 W. MARCH LANE
Practice Address - Street 2:SUITE A
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5723
Practice Address - Country:US
Practice Address - Phone:209-477-5552
Practice Address - Fax:209-477-5553
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14421363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant