=====================================================
General NPI Number Information
=====================================================
NPI Number | 1952555245
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MRS. REGINA MATUAN BONITE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2008
-----------------------------------------------------
Last Update Date | 11/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13638 BRANFORD ST
-----------------------------------------------------
City | ARLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-6209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-472-5347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13638 BRANFORD ST
-----------------------------------------------------
City | ARLETA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91331-6209
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-472-5347
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164X00000X
-----------------------------------------------------
Taxonomy Name | Licensed Vocational Nurse
-----------------------------------------------------
License Number | VN 175829
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------