Provider Demographics
NPI:1235435231
Name:MARCELLA BONNICI, M.D. PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:MARCELLA BONNICI, M.D. PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCELLA
Authorized Official - Middle Name:A
Authorized Official - Last Name:BONNICI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-816-3233
Mailing Address - Street 1:36320 INLAND VALLEY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WILDOMAR
Mailing Address - State:CA
Mailing Address - Zip Code:92595-7512
Mailing Address - Country:US
Mailing Address - Phone:951-816-3233
Mailing Address - Fax:951-816-3240
Practice Address - Street 1:36320 INLAND VALLEY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7512
Practice Address - Country:US
Practice Address - Phone:951-816-3233
Practice Address - Fax:951-816-3240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-08
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care