=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326341942
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LAURA MELANIA BONDONNO M.F.T.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/21/2010
-----------------------------------------------------
Last Update Date | 12/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1255 TREAT BLVD SUITE 300
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94597-7968
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 877-823-0909
-----------------------------------------------------
Fax | 707-647-7007
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1201 GLEN COVE PKWY SUITE 203
-----------------------------------------------------
City | VALLEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94591-7171
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 707-647-7007
-----------------------------------------------------
Fax | 707-647-7007
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 48212
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------