Healthcare Provider Details

I. General information

NPI: 1376848168
Provider Name (Legal Business Name): VICTOR PAUL BONFILIO PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2011
Last Update Date: 01/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2252 FILLMORE ST
SAN FRANCISCO CA
94115-2222
US

IV. Provider business mailing address

2252 FILLMORE ST
SAN FRANCISCO CA
94115-2222
US

V. Phone/Fax

Practice location:
  • Phone: 415-922-2281
  • Fax:
Mailing address:
  • Phone: 415-922-2281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License NumberPSY7428
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY7428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: