MEDICARE: TEODORA M. BONUAN MD A MED CORP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316962194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TEODORA M. BONUAN MD A MED CORP

Provider Business Mailing Address
First Line	:	10230 ARTESIA BLVD
Second Line	:	SUITE 300
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-6763
Country	:	US
Telephone Number	:	562-804-1311
Fax Number	:	562-804-2263

Provider Business Practice Location Address
First Line	:	10230 ARTESIA BLVD
Second Line	:	SUITE 300
City	:	BELLFLOWER
State	:	CA
Zip	:	90706-6763
Country	:	US
Telephone Number	:	562-804-1311
Fax Number	:	562-804-2263

Authorized Official
Title or Position	:	PRESIDENT
Name	:	TEODORA MALALUAN BONUAN
Credential	:	MD
Telephone Number	:	562-804-1311

Provider Enumeration Date	:	07/13/2006
Last Update Date	:	08/22/2020

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