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NPI Code Detail

MEDICARE: KHAMEELAH DESTINY BONNER LPT

MEDICARE: KHAMEELAH DESTINY BONNER LPT
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
1167G00000XLicensed Psychiatric Technician43121CA

General Provider Information

NPI Number : 1871444158
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHAMEELAH DESTINY BONNER LPT
Provider Business Mailing Address
First Line : 1414 N CALIFORNIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1515
Country : US
Telephone Number : 209-468-6820
Fax Number :
Provider Business Practice Location Address
First Line : 1414 N CALIFORNIA ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-1515
Country : US
Telephone Number : 209-468-6820
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/04/2026
Last Update Date : 02/04/2026

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Directions to “ KHAMEELAH DESTINY BONNER LPT” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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