Healthcare Provider Details

I. General information

NPI: 1235117128
Provider Name (Legal Business Name): VIVIEN BONERT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 05/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD.
LOS ANGELES CA
90048-1865
US

IV. Provider business mailing address

PO BOX 512717
LOS ANGELES CA
90051-0717
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5000
  • Fax:
Mailing address:
  • Phone: 310-423-2830
  • Fax: 310-423-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA50321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: