Provider Demographics
NPI:1376842328
Name:ORANGE COUNTY UROGYNECOLOGY, A MEDICAL CORP.
Entity Type:Organization
Organization Name:ORANGE COUNTY UROGYNECOLOGY, A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-770-1706
Mailing Address - Street 1:25108 MARGUERITE PKWY
Mailing Address - Street 2:A-259
Mailing Address - City:MISSION VIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92692
Mailing Address - Country:US
Mailing Address - Phone:310-770-1706
Mailing Address - Fax:866-545-3197
Practice Address - Street 1:25108 MARGUERITE PKWY
Practice Address - Street 2:A-259
Practice Address - City:MISSION VIEGO
Practice Address - State:CA
Practice Address - Zip Code:92692
Practice Address - Country:US
Practice Address - Phone:310-770-1706
Practice Address - Fax:866-545-3197
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207V00000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty