Healthcare Provider Details

I. General information

NPI: 1316442874
Provider Name (Legal Business Name): ANTHONY FRANCIS BONZAGNI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2018
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 PACIFIC COAST HWY
HARBOR CITY CA
90710-3500
US

IV. Provider business mailing address

1050 PACIFIC COAST HWY
HARBOR CITY CA
90710-3500
US

V. Phone/Fax

Practice location:
  • Phone: 424-328-2510
  • Fax:
Mailing address:
  • Phone: 424-328-2510
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number23543
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: