Healthcare Provider Details

I. General information

NPI: 1831275981
Provider Name (Legal Business Name): BONNIE CORY N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 02/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12358 POWAY RD
POWAY CA
92064-4219
US

IV. Provider business mailing address

14592 KENNEBUNK ST
POWAY CA
92064-5923
US

V. Phone/Fax

Practice location:
  • Phone: 858-748-9220
  • Fax:
Mailing address:
  • Phone: 858-679-2747
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP10373
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: