Healthcare Provider Details

I. General information

NPI: 1487924718
Provider Name (Legal Business Name): MICHAEL JAY BONE DVM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2012
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8311 GREENBACK LN
FAIR OAKS CA
95628-2606
US

IV. Provider business mailing address

8311 GREENBACK LN
FAIR OAKS CA
95628-2606
US

V. Phone/Fax

Practice location:
  • Phone: 916-725-1541
  • Fax: 916-725-4584
Mailing address:
  • Phone: 916-725-1541
  • Fax: 916-725-4584

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number5954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: