Healthcare Provider Details

I. General information

NPI: 1508113432
Provider Name (Legal Business Name): MR. DANIEL LAWRENCE BONHAM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2012
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2060 CAMPUS DRIVE
YERKA CA
96094
US

IV. Provider business mailing address

2060 CAMPUS DR
YREKA CA
96097-9538
US

V. Phone/Fax

Practice location:
  • Phone: 530-841-4100
  • Fax: 530-841-4841
Mailing address:
  • Phone: 530-841-4100
  • Fax: 530-841-4799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: