Provider Demographics
NPI:1134133572
Name:BOBZIEN, BONNIE RUTH (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:RUTH
Last Name:BOBZIEN
Suffix:
Gender:F
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:PO BOX 2829
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-5829
Mailing Address - Country:US
Mailing Address - Phone:619-325-8726
Mailing Address - Fax:619-325-8728
Practice Address - Street 1:4002 VISTA WAY
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4506
Practice Address - Country:US
Practice Address - Phone:760-634-3230
Practice Address - Fax:760-940-7934
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48863207ZP0102X
IL036-101882207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G488630Medicaid
CA220006738Medicare PIN
CA00G488630Medicaid
CAWG48863AMedicare PIN