Provider Demographics
NPI:1275770331
Name:HARAGOS, BONNIE (LVN)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:HARAGOS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 S CITRUS AVE
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92027-4202
Mailing Address - Country:US
Mailing Address - Phone:760-715-2700
Mailing Address - Fax:
Practice Address - Street 1:518 S CITRUS AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-4202
Practice Address - Country:US
Practice Address - Phone:760-738-8958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN-150196164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse