MEDICARE: CARINA LEILANI BONDOC

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	1041C0700X	Clinical Social Worker	110354	CA

General Provider Information

NPI Number	:	1790492478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARINA LEILANI BONDOC

Provider Business Mailing Address
First Line	:	10545 GIFFIN WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-3049
Country	:	US
Telephone Number	:	619-944-8268
Fax Number	:

Provider Business Practice Location Address
First Line	:	10545 GIFFIN WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-3049
Country	:	US
Telephone Number	:	619-944-8268
Fax Number	:

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

Provider Enumeration Date	:	11/01/2022
Last Update Date	:	11/01/2022

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Directions to “ CARINA LEILANI BONDOC ” Practice Location

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