Provider Demographics
NPI:1649421116
Name:BONO FOLTZ, JUSTINE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:JUSTINE
Middle Name:MICHELLE
Last Name:BONO FOLTZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JUSTINE
Other - Middle Name:MICHELLE
Other - Last Name:BONO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:14476 JANAL WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-1626
Mailing Address - Country:US
Mailing Address - Phone:858-414-1770
Mailing Address - Fax:
Practice Address - Street 1:3350 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-6526
Practice Address - Country:US
Practice Address - Phone:858-642-3617
Practice Address - Fax:858-642-1198
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2019-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18188363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health