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General NPI Number Information
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NPI Number | 1720565070
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Entity Type | Individual
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Provider Name | MARCELIANO BONAFE
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Gender | Male
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Dates
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Enumeration Date | 07/19/2018
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Last Update Date | 08/12/2024
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Provider Practice Location Address
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Address Line | 3055 WILSHIRE BLVD STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90010-1147
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Country | US
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Telephone | 213-241-3841
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Fax |
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Provider Business Mailing Address
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Address Line | 3055 WILSHIRE BLVD STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90010-1147
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 124962
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License Number State | CA
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