Provider Demographics
NPI:1770736456
Name:UROGYNECOLOGY ASSOCIATES, A MEDICAL CORPORATION
Entity type:Organization
Organization Name:UROGYNECOLOGY ASSOCIATES, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARAM
Authorized Official - Middle Name:
Authorized Official - Last Name:BONNI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-265-4500
Mailing Address - Street 1:82 CINNAMON TEAL
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1835
Mailing Address - Country:US
Mailing Address - Phone:657-888-3008
Mailing Address - Fax:657-888-9181
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-7329
Practice Address - Country:US
Practice Address - Phone:657-888-3008
Practice Address - Fax:657-888-9181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA66385OtherCALIFORNIA MEDICAL LICENSE
CA11404859164Medicaid
CAG82695Medicare UPIN
CA11404859164Medicaid