Provider Demographics
NPI:1255441457
Name:BOVONE, SUZANNE (MD)
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:
Last Name:BOVONE
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 1:900 E. HAMILTON AVENUE
Mailing Address - Street 2:SUITE 220
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-516-0300
Mailing Address - Fax:408-608-6135
Practice Address - Street 1:900 E. HAMILTON AVENUE
Practice Address - Street 2:SUITE 220
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-516-0300
Practice Address - Fax:408-608-6135
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA71488207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A714880Medicaid
CA00A714880Medicare ID - Type Unspecified
CA00A714880Medicaid