Provider Demographics
NPI:1790492478
Name:BONDOC, CARINA LEILANI
Entity Type:Individual
Prefix:
First Name:CARINA
Middle Name:LEILANI
Last Name:BONDOC
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 1:10545 GIFFIN WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-3049
Mailing Address - Country:US
Mailing Address - Phone:619-944-8268
Mailing Address - Fax:
Practice Address - Street 1:10545 GIFFIN WAY
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-3049
Practice Address - Country:US
Practice Address - Phone:619-944-8268
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-01
Last Update Date:2022-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1103541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical