Provider Demographics
NPI:1245369651
Name:BONFANTI, DAVID ALAN II (LMFT # 43891)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ALAN
Last Name:BONFANTI
Suffix:II
Gender:M
Credentials:LMFT # 43891
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:A
Other - Last Name:BONFANTI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:23705 VANOWEN ST
Mailing Address - Street 2:# 289
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3030
Mailing Address - Country:US
Mailing Address - Phone:818-274-7677
Mailing Address - Fax:
Practice Address - Street 1:5012 CHESEBRO RD STE 200
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301
Practice Address - Country:US
Practice Address - Phone:818-274-7677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43891106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00007300Medicaid