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General NPI Number Information
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NPI Number | 1255696654
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Entity Type | Organization
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Legal Business Name | ESTEBAN BONFANTE MD INC
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 08/11/2014
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Provider Practice Location Address
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Address Line | 1000 NEWBURY RD SUITE 285
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City | NEWBURY PARK
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State | CA
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Zip | 91320-6435
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Country | US
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Telephone | 805-376-0277
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Fax | 805-376-0244
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Provider Business Mailing Address
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Address Line | PO BOX 3098
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City | TORRANCE
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State | CA
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Zip | 90510-3098
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Country | US
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Telephone | 310-792-3914
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Fax | 855-898-4055
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Authorized Official
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Title or Position | PRESIDENT/ OWNER
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Name | ESTEBAN BONFANTE
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Credential | M.D.
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Telephone | 310-792-3914
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | A86766
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | A86766
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License Number State | CA
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