Provider Demographics
NPI:1275939332
Name:BONNAUD, JEFFREY MICHAEL (MHS, PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:MICHAEL
Last Name:BONNAUD
Suffix:
Gender:M
Credentials:MHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 S FIGUEROA ST STE 1050
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-5310
Mailing Address - Country:US
Mailing Address - Phone:213-319-3339
Mailing Address - Fax:
Practice Address - Street 1:888 S FIGUEROA ST STE 1050
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-5310
Practice Address - Country:US
Practice Address - Phone:213-319-3339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-17
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA58902363AM0700X
MAMAPA5192363AM0700X
MAPA5192363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical