Provider Demographics
NPI:1134381619
Name:BAHAMONDE, LOURDES G (DO)
Entity type:Individual
Prefix:DR
First Name:LOURDES
Middle Name:G
Last Name:BAHAMONDE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LOURDES
Other - Middle Name:GONZALEZ
Other - Last Name:BAHAMONDE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:147 N MAYFLOWER AVE
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-2005
Mailing Address - Country:US
Mailing Address - Phone:516-526-9192
Mailing Address - Fax:
Practice Address - Street 1:7643 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:CUDAHY
Practice Address - State:CA
Practice Address - Zip Code:90201-5019
Practice Address - Country:US
Practice Address - Phone:213-373-1265
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY254878207RG0100X
CA20A13517207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology