Healthcare Provider Details

I. General information

NPI: 1467736355
Provider Name (Legal Business Name): BONNIE SUE MORALES FNP, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BONNIE SUE POYTRESS FNP, RN

II. Dates (important events)

Enumeration Date: 10/11/2011
Last Update Date: 10/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 N ELECTRIC AVE APT K
ALHAMBRA CA
91801-1927
US

IV. Provider business mailing address

126 N ELECTRIC AVE APT K
ALHAMBRA CA
91801-1927
US

V. Phone/Fax

Practice location:
  • Phone: 949-293-3169
  • Fax:
Mailing address:
  • Phone: 949-293-3169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number737631
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20329
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: