Provider Demographics
NPI:1780602425
Name:MARTIN, BONNIE B (CNM, ARNP)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:B
Last Name:MARTIN
Suffix:
Gender:F
Credentials:CNM, ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24401 HEALTH CENTER DR., SUITE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653
Mailing Address - Country:US
Mailing Address - Phone:949-770-4115
Mailing Address - Fax:949-770-3422
Practice Address - Street 1:24401 HEALTH CENTER DR., SUITE 300
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653
Practice Address - Country:US
Practice Address - Phone:949-770-4115
Practice Address - Fax:949-770-3422
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACNM236497367A00000X
WARN00154078163W00000X
WAAP30006787367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642976Medicaid
WA1018722Medicaid
WA1018722Medicaid
WA9642976Medicaid