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1669503785 NPI number — ROBERT L. BONACCI FNP, PA

NPI Number: 1669503785
Health Care Provider/Practitioner: ROBERT L. BONACCI FNP, PA

Information about “1669503785” NPI (ROBERT L. BONACCI FNP, PA) exists in 1669503785 in HTML format HTML  |  1669503785 in plain Text format TXT  |  1669503785 in PDF (Portable Document Format) PDF  |  1669503785 in an XML format XML  formats.

NPI Number : 1669503785 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1669503785",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BONACCI",
    "FirstName": "ROBERT",
    "MiddleName": "L.",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "FNP, PA",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "8383 OAKWOOD HILLS CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CITRUS HEIGHTS",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95610-0850",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "916-802-4454",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "401 I ST",
    "SecondLinePracticeLocationAddress": "SUITE A",
    "PracticeLocationAddressCityName": "MARYSVILLE",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95901-5626",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "530-749-4461",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/08/2007",
    "LastUpdateDate": "07/19/2013",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "363A00000X",
          "TaxonomyName": "Physician Assistant",
          "LicenseNumber": "PA10944",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "363LF0000X",
          "TaxonomyName": "Family Nurse Practitioner",
          "LicenseNumber": "220972",
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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