Healthcare Provider Details

I. General information

NPI: 1508435355
Provider Name (Legal Business Name): LIANE C. BONDOC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1206 E 17TH ST
SANTA ANA CA
92701-2641
US

IV. Provider business mailing address

1206 E 17TH ST
SANTA ANA CA
92701-2641
US

V. Phone/Fax

Practice location:
  • Phone: 714-352-2911
  • Fax: 714-352-2903
Mailing address:
  • Phone: 714-352-2911
  • Fax: 714-352-2903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number153076
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: