Provider Demographics
NPI:1740081546
Name:BONAVENTURA, SOFIA IZABELLA
Entity type:Individual
Prefix:
First Name:SOFIA
Middle Name:IZABELLA
Last Name:BONAVENTURA
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 1:28245 AVENUE CROCKER STE 220
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1201
Mailing Address - Country:US
Mailing Address - Phone:661-254-7086
Mailing Address - Fax:
Practice Address - Street 1:28875 ROCK CANYON DR
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91390-5280
Practice Address - Country:US
Practice Address - Phone:661-644-0979
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-19
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician