Healthcare Provider Details

I. General information

NPI: 1275566259
Provider Name (Legal Business Name): ORANGE COUNTY UROGYNECOLOGY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26012 MARGUERITE PKWY H-105
MISSION VIEJO CA
92692-3263
US

IV. Provider business mailing address

26012 MARGUERITE PKWY H-105
MISSION VIEJO CA
92692-3263
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-1706
  • Fax:
Mailing address:
  • Phone: 310-770-1706
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA66385
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA66385
License Number StateCA

VIII. Authorized Official

Name: ARAM BONNI
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-770-1706