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General NPI Number Information
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NPI Number | 1164295754
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Entity Type | Organization
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Legal Business Name | JENNIFER M L BONI MD PC
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Dates
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Enumeration Date | 11/06/2023
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Last Update Date | 09/27/2024
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Provider Practice Location Address
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Address Line | 3330 CAMERON PARK DR STE 250
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City | CAMERON PARK
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State | CA
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Zip | 95682-7671
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Country | US
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Telephone | 530-929-7493
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Fax |
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Provider Business Mailing Address
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Address Line | 2001 GOLDORADO TRL
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City | EL DORADO
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State | CA
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Zip | 95623-4521
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Country | US
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Telephone | 612-600-5366
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JENNIFER MADELINE LEE BONI
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Credential | MD
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Telephone | 612-600-5366
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2083B0002X
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Taxonomy Name | Obesity Medicine (Preventive Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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