MEDICARE: LAURA BONELLI 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
1	207W00000X	Ophthalmology Physician	A117107	CA

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	:	1861649345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA BONELLI M.D.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-825-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 STEIN PLAZA
Second Line	:	RM# 1-340
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7001
Country	:	US
Telephone Number	:	310-825-5000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2008
Last Update Date	:	10/14/2011

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Directions to “ LAURA BONELLI M.D.” Practice Location

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