Provider Demographics
NPI:1821062878
Name:HOOPER, BONNIE JEAN (NP)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:HOOPER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SANTA FE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-5138
Mailing Address - Country:US
Mailing Address - Phone:760-753-3424
Mailing Address - Fax:760-753-3425
Practice Address - Street 1:320 SANTA FE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-5138
Practice Address - Country:US
Practice Address - Phone:760-753-3424
Practice Address - Fax:760-753-3425
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP6495363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
S68782Medicare UPIN
CAZZZ02261ZMedicare ID - Type UnspecifiedNORTHERN CA
CAW19415Medicare ID - Type UnspecifiedSOUTHERN CA