Provider Demographics
NPI:1326312794
Name:BONAVENTURE CLINIC
Entity Type:Organization
Organization Name:BONAVENTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:STEFFY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-386-7055
Mailing Address - Street 1:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:SOMIS
Mailing Address - State:CA
Mailing Address - Zip Code:93066-0429
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1081 MESA DR
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-1345
Practice Address - Country:US
Practice Address - Phone:805-386-7055
Practice Address - Fax:805-386-7038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116565207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty