Provider Demographics
NPI:1851379796
Name:BONALDI, LAWRENCE PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:PAUL
Last Name:BONALDI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1343 NORTH GRAND AVENUE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91724-1016
Mailing Address - Country:US
Mailing Address - Phone:305-808-4034
Mailing Address - Fax:
Practice Address - Street 1:670 N MCCARTHY BLVD STE 220
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-5119
Practice Address - Country:US
Practice Address - Phone:800-953-5995
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG34176207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR942609963OtherFEDERAL TAX I.D. NUMBER
CA00G341760Medicare ID - Type Unspecified
CAA45817Medicare UPIN