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General NPI Number Information
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NPI Number | 1326312794
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Entity Type | Organization
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Legal Business Name | BONAVENTURE CLINIC
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Dates
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Enumeration Date | 03/02/2012
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Last Update Date | 06/08/2012
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Provider Practice Location Address
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Address Line | 1081 MESA DR
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City | CAMARILLO
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State | CA
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Zip | 93010-1345
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Country | US
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Telephone | 805-386-7055
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Fax | 805-386-7038
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Provider Business Mailing Address
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Address Line | PO BOX 429
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City | SOMIS
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State | CA
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Zip | 93066-0429
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DANIEL STEFFY
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Credential | M.D.
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Telephone | 805-386-7055
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A116565
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License Number State | CA
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