Provider Demographics
NPI:1265649487
Name:BONETI, CRISTIANO (MD)
Entity Type:Individual
Prefix:DR
First Name:CRISTIANO
Middle Name:
Last Name:BONETI
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 1:416 N BEDFORD DR STE 100
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4308
Mailing Address - Country:US
Mailing Address - Phone:305-951-6543
Mailing Address - Fax:424-324-3880
Practice Address - Street 1:416 N BEDFORD DR STE 100
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4308
Practice Address - Country:US
Practice Address - Phone:310-993-4679
Practice Address - Fax:424-324-3880
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2023-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4583208600000X
CAA149114208600000X
FLME123614208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR177383001Medicaid
AR177383001Medicaid