Provider Demographics
NPI:1619670775
Name:BONNYMAN, CLAIRE WEBB
Entity Type:Individual
Prefix:
First Name:CLAIRE
Middle Name:WEBB
Last Name:BONNYMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4016 HERSCHEL AVE APT A
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2933
Mailing Address - Country:US
Mailing Address - Phone:865-765-7883
Mailing Address - Fax:
Practice Address - Street 1:9300 CAMPUS POINT DR # 7894
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1300
Practice Address - Country:US
Practice Address - Phone:865-765-7883
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program