=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861470197
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BONNIE JEAN HARTMAN MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/06/2006
-----------------------------------------------------
Last Update Date | 05/04/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7224 S RECOVERY RD
-----------------------------------------------------
City | FRENCH CAMP
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95231-8901
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 209-888-6595
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 30206 HILLSIDE TER
-----------------------------------------------------
City | SAN JUAN CAPISTRANO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92675-1541
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 509-859-3478
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | MD00034707
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0804X
-----------------------------------------------------
Taxonomy Name | Child & Adolescent Psychiatry Physician
-----------------------------------------------------
License Number | C175390
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number | C175390
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------