Healthcare Provider Details

I. General information

NPI: 1275199705
Provider Name (Legal Business Name): SVITLANA BONDAR NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE LL15
ENCINO CA
91436-4931
US

IV. Provider business mailing address

15211 VANOWEN ST STE 209
VAN NUYS CA
91405-3624
US

V. Phone/Fax

Practice location:
  • Phone: 818-905-1567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95010208
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95010208
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number1275199705
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: