Healthcare Provider Details

I. General information

NPI: 1215554480
Provider Name (Legal Business Name): ASHLEY BONZELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/02/2020
Last Update Date: 07/02/2020
Certification Date: 07/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 W 213TH ST STE 100
TORRANCE CA
90501-2852
US

IV. Provider business mailing address

426 N CURSON AVE
LOS ANGELES CA
90036-2341
US

V. Phone/Fax

Practice location:
  • Phone: 310-328-0276
  • Fax:
Mailing address:
  • Phone: 310-405-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: