Provider Demographics
NPI:1912191164
Name:TAO, BONITA (MD)
Entity Type:Individual
Prefix:DR
First Name:BONITA
Middle Name:
Last Name:TAO
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 1:11565 ALDERHILL TER
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3855
Mailing Address - Country:US
Mailing Address - Phone:858-863-7884
Mailing Address - Fax:
Practice Address - Street 1:7051 ALVARADO RD
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-8901
Practice Address - Country:US
Practice Address - Phone:619-460-7775
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96323207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine