Provider Demographics
NPI:1952400574
Name:LANCE, BONNIE J (DPM)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:J
Last Name:LANCE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 W WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4639
Mailing Address - Country:US
Mailing Address - Phone:323-890-0073
Mailing Address - Fax:323-490-7711
Practice Address - Street 1:1000 W WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4639
Practice Address - Country:US
Practice Address - Phone:323-890-0073
Practice Address - Fax:323-490-7711
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2019-05-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE3702213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU00875Medicare UPIN