Provider Demographics
NPI:1801866827
Name:BONNER, SYLVIA MARIELLA FIRNHABER (MD)
Entity Type:Individual
Prefix:DR
First Name:SYLVIA
Middle Name:MARIELLA FIRNHABER
Last Name:BONNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2423 W DUNLAP AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85021-5818
Mailing Address - Country:US
Mailing Address - Phone:602-468-0317
Mailing Address - Fax:602-468-0350
Practice Address - Street 1:2423 W DUNLAP AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-2830
Practice Address - Country:US
Practice Address - Phone:602-468-0317
Practice Address - Fax:602-468-0350
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ27091174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ3053151Medicaid
BF2117794OtherDEA
AZ3053151Medicaid