Provider Demographics
NPI:1417228644
Name:BONAKDAR, MONICA (MD)
Entity Type:Individual
Prefix:DR
First Name:MONICA
Middle Name:
Last Name:BONAKDAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20321 IRVINE AVE STE F3
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-0269
Mailing Address - Country:US
Mailing Address - Phone:949-721-6000
Mailing Address - Fax:949-721-6006
Practice Address - Street 1:20321 IRVINE AVE STE F3
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0269
Practice Address - Country:US
Practice Address - Phone:949-721-6000
Practice Address - Fax:949-721-6006
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-19
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG076534207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology