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General NPI Number Information
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NPI Number | 1609117175
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Entity Type | Organization
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Legal Business Name | SHANNON BONNESS MD PC
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Dates
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Enumeration Date | 03/08/2013
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Last Update Date | 03/08/2013
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Provider Practice Location Address
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Address Line | 614 W DUARTE RD
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City | ARCADIA
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State | CA
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Zip | 91007-7601
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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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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 | SHANNON BONNESS
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Credential | MD
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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 | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | C55574
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License Number State | CA
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