Provider Demographics
NPI:1013131390
Name:ONUBAH, BONIFACE O (MD)
Entity Type:Individual
Prefix:DR
First Name:BONIFACE
Middle Name:O
Last Name:ONUBAH
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 1:14560 MAGNOLIA ST
Mailing Address - Street 2:STE 101
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-4791
Mailing Address - Country:US
Mailing Address - Phone:714-889-2150
Mailing Address - Fax:
Practice Address - Street 1:14560 MAGNOLIA ST
Practice Address - Street 2:STE 101
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-4791
Practice Address - Country:US
Practice Address - Phone:714-889-2150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA524152084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF72015Medicare UPIN
CAA52415AMedicare ID - Type UnspecifiedMEDICARE NUMBER