Healthcare Provider Details

I. General information

NPI: 1598786048
Provider Name (Legal Business Name): WENDY LYNN BONNAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY LYNN STAFFORD BEEMAN

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 VALE TERRACE DR
VISTA CA
92084-5218
US

IV. Provider business mailing address

5978 BERTRO DR
LA MESA CA
91942-1821
US

V. Phone/Fax

Practice location:
  • Phone: 760-407-1220
  • Fax: 760-414-3702
Mailing address:
  • Phone: 619-589-6992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number7950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: