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NPI Code Detail

MEDICARE: JENNIFER MADELINE LEE BONI M.D.

MEDICARE: JENNIFER MADELINE LEE BONI M.D.
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
1207V00000XObstetrics & Gynecology PhysicianC173221CA

General Provider Information

NPI Number : 1558570911
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MADELINE LEE BONI M.D.
Provider Business Mailing Address
First Line : 4212 MISSOURI FLAT RD
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-6269
Country : US
Telephone Number : 530-621-7700
Fax Number : 530-621-7713
Provider Business Practice Location Address
First Line : 4212 MISSOURI FLAT RD
Second Line :
City : PLACERVILLE
State : CA
Zip : 95667-6269
Country : US
Telephone Number : 530-621-7700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/22/2007
Last Update Date : 07/09/2025

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