Provider Demographics
NPI:1508933607
Name:MASSA, BONNI S (MD)
Entity Type:Individual
Prefix:
First Name:BONNI
Middle Name:S
Last Name:MASSA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2100 WEBSTER ST
Mailing Address - Street 2:SUITE 319
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-2373
Mailing Address - Country:US
Mailing Address - Phone:415-923-3123
Mailing Address - Fax:415-923-3132
Practice Address - Street 1:2100 WEBSTER ST
Practice Address - Street 2:SUITE 319
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-2373
Practice Address - Country:US
Practice Address - Phone:415-923-3123
Practice Address - Fax:415-923-3132
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2015-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67511207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
No207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH55456Medicare UPIN
CA00G653010Medicare ID - Type Unspecified