Healthcare Provider Details

I. General information

NPI: 1700834496
Provider Name (Legal Business Name): BONNIE DELL FLANNIGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2428 SANTA MONICA BLVD
SANTA MONICA CA
90404-2045
US

IV. Provider business mailing address

1516 COTNER AVENUE
LOS ANGELES CA
90025-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-315-1000
  • Fax:
Mailing address:
  • Phone: 310-445-2951
  • Fax: 310-479-1459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License NumberA34520
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License NumberA34520
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA34520
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code2085D0003X
TaxonomyDiagnostic Neuroimaging (Radiology) Physician
License NumberA34520
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: