Provider Demographics
NPI:1629060322
Name:MARTINO, BONNALYN JOAN (FNP)
Entity Type:Individual
Prefix:MS
First Name:BONNALYN
Middle Name:JOAN
Last Name:MARTINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 MERRIEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5554
Mailing Address - Country:US
Mailing Address - Phone:925-283-5482
Mailing Address - Fax:
Practice Address - Street 1:200 MUIR RD
Practice Address - Street 2:KAISER MEDICAL OFFICES - MEDICINE F
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4614
Practice Address - Country:US
Practice Address - Phone:925-372-1740
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN286348363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP17851/ZZZ19250ZMedicare UPIN