Healthcare Provider Details

I. General information

NPI: 1730105859
Provider Name (Legal Business Name): RHAELYNN BONHAM NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 SANTA ROSA ST STE 201
SAN LUIS OBISPO CA
93405-5825
US

IV. Provider business mailing address

PO BOX 4659
SAN LUIS OBISPO CA
93403-4659
US

V. Phone/Fax

Practice location:
  • Phone: 805-597-8386
  • Fax: 805-592-2392
Mailing address:
  • Phone: 805-597-8386
  • Fax: 805-592-2392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP1700X
TaxonomyPerinatal Registered Nurse
License Number602764
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: