Healthcare Provider Details

I. General information

NPI: 1841121811
Provider Name (Legal Business Name): MARY SOWJANYA BONIGE MSC., CCC- SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 N DIAMOND BAR BLVD STE B
DIAMOND BAR CA
91765-1059
US

IV. Provider business mailing address

706 N DIAMOND BAR BLVD STE B
DIAMOND BAR CA
91765-1059
US

V. Phone/Fax

Practice location:
  • Phone: 310-951-8677
  • Fax:
Mailing address:
  • Phone: 310-951-8677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number33126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: