Provider Demographics
NPI:1801947817
Name:GINTIS, BONNIE (DO)
Entity type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:
Last Name:GINTIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3233 VALENCIA AVENUE
Mailing Address - Street 2:SUITE B6
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4127
Mailing Address - Country:US
Mailing Address - Phone:831-688-4201
Mailing Address - Fax:831-688-4695
Practice Address - Street 1:3233 VALENCIA AVENUE
Practice Address - Street 2:SUITE B6
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4127
Practice Address - Country:US
Practice Address - Phone:831-688-4201
Practice Address - Fax:831-688-4695
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7142204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE48972Medicare UPIN