Healthcare Provider Details

I. General information

NPI: 1285947952
Provider Name (Legal Business Name): RICHARD BENJAMIN BONNES PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2010
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NMRTC CP 41 AREA MCMH 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

NMRTC CP 41 AREA MCMH 200 MERCY CIRCLE
CAMP PENDLETON CA
92055
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1861
  • Fax:
Mailing address:
  • Phone: 760-725-1861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: