Provider Demographics
NPI:1477347474
Name:BONIFACIO, CLOWEE LYKA VALDEZ
Entity type:Individual
Prefix:
First Name:CLOWEE LYKA
Middle Name:VALDEZ
Last Name:BONIFACIO
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2832 SAND POINT DR
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2920
Mailing Address - Country:US
Mailing Address - Phone:408-912-6917
Mailing Address - Fax:
Practice Address - Street 1:2832 SAND POINT DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95148-2920
Practice Address - Country:US
Practice Address - Phone:408-912-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Multi-Specialty