MEDICARE: HALEY BONFANTE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1023874187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HALEY BONFANTE

Provider Business Mailing Address
First Line	:	2141 PALOMAR AIRPORT RD STE 350
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8228 STATION VILLAGE LN APT 1503
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-5546
Country	:	US
Telephone Number	:	408-607-8187
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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Directions to “ HALEY BONFANTE ” Practice Location

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