Provider Demographics
NPI:1235153974
Name:BEAVER, BONNIE (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BEAVER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:BONNIE
Other - Middle Name:
Other - Last Name:ROBERTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7230 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 602
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-1907
Mailing Address - Country:US
Mailing Address - Phone:818-888-3437
Mailing Address - Fax:818-877-7919
Practice Address - Street 1:7230 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 602
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1907
Practice Address - Country:US
Practice Address - Phone:818-888-3437
Practice Address - Fax:818-877-7919
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG49731207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92926Medicare UPIN