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General NPI Number Information
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NPI Number | 1740375567
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Entity Type | Individual
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Provider Name | GREGORY ALLEN BONOMO DPT
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 11/19/2008
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Provider Practice Location Address
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Address Line | 9120 CHURCH ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-2103
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Country | US
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Telephone | 626-378-5827
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Fax |
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Provider Business Mailing Address
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Address Line | 13007 BERMUDA AVE
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City | CHINO
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State | CA
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Zip | 91710-4563
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Country | US
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Telephone | 626-378-5827
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | PT25391
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License Number State | CA
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