Provider Demographics
NPI:1669503785
Name:BONACCI, ROBERT L (FNP, PA)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:L
Last Name:BONACCI
Suffix:
Gender:M
Credentials:FNP, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8383 OAKWOOD HILLS CIR
Mailing Address - Street 2:
Mailing Address - City:CITRUS HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:95610-0850
Mailing Address - Country:US
Mailing Address - Phone:916-802-4454
Mailing Address - Fax:
Practice Address - Street 1:401 I ST
Practice Address - Street 2:SUITE A
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-5626
Practice Address - Country:US
Practice Address - Phone:530-749-4461
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10944363A00000X
CA220972363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily