Provider Demographics
NPI:1881852374
Name:BUFKIN, BONNIE
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BUFKIN
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 1:26465 CARMEL RANCHO BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:CARMEL
Mailing Address - State:CA
Mailing Address - Zip Code:93923-8747
Mailing Address - Country:US
Mailing Address - Phone:831-521-5597
Mailing Address - Fax:
Practice Address - Street 1:26465 CARMEL RANCHO BLVD
Practice Address - Street 2:STE 3
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8747
Practice Address - Country:US
Practice Address - Phone:831-521-5597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2008-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF52570106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist