Provider Demographics
NPI:1104859164
Name:BONNI, ARAM (MD)
Entity Type:Individual
Prefix:
First Name:ARAM
Middle Name:
Last Name:BONNI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 CINNAMON TEAL
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1835
Mailing Address - Country:US
Mailing Address - Phone:310-770-1706
Mailing Address - Fax:
Practice Address - Street 1:14550 HAYNES ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91411-1613
Practice Address - Country:US
Practice Address - Phone:657-888-3008
Practice Address - Fax:657-888-9181
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA66385207VG0400X, 208800000X, 207VF0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VF0040XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyFemale Pelvic Medicine and Reconstructive Surgery
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66385OtherCA STATE MED LICENSE
CABB4653831OtherDEA
CAA66385OtherCA STATE MED LICENSE