Healthcare Provider Details

I. General information

NPI: 1477607463
Provider Name (Legal Business Name): JAMES BON FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2007
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

IV. Provider business mailing address

1530 HILLHURST AVE
LOS ANGELES CA
90027-5516
US

V. Phone/Fax

Practice location:
  • Phone: 323-644-3880
  • Fax: 323-644-3892
Mailing address:
  • Phone: 323-644-3880
  • Fax: 323-644-3892

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number541361
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP15988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: