Provider Demographics
NPI:1952555245
Name:BONITE, REGINA MATUAN
Entity Type:Individual
Prefix:MRS
First Name:REGINA
Middle Name:MATUAN
Last Name:BONITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13638 BRANFORD ST
Mailing Address - Street 2:
Mailing Address - City:ARLETA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-6209
Mailing Address - Country:US
Mailing Address - Phone:818-472-5347
Mailing Address - Fax:
Practice Address - Street 1:13638 BRANFORD ST
Practice Address - Street 2:
Practice Address - City:ARLETA
Practice Address - State:CA
Practice Address - Zip Code:91331-6209
Practice Address - Country:US
Practice Address - Phone:818-472-5347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-12
Last Update Date:2008-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 175829164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse