Healthcare Provider Details

I. General information

NPI: 1013598705
Provider Name (Legal Business Name): MICHELLE SOCORRO BONDERO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE DIDERO MD

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 CITY BLVD W STE 1400
ORANGE CA
92868-5900
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 714-456-8224
  • Fax: 714-456-8360
Mailing address:
  • Phone: 310-301-5200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA196859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: