MEDICARE: DR. BONITA TAO 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	207Q00000X	Family Medicine Physician	A96323	CA

General Provider Information

NPI Number	:	1912191164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BONITA TAO M.D.

Provider Business Mailing Address
First Line	:	10755 SCRIPPS POWAY PKWY # 363
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3924
Country	:	US
Telephone Number	:	858-863-7884
Fax Number	:

Provider Business Practice Location Address
First Line	:	10755 SCRIPPS POWAY PKWY # 363
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-3924
Country	:	US
Telephone Number	:	858-863-7884
Fax Number	:

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

Provider Enumeration Date	:	08/30/2007
Last Update Date	:	10/25/2024

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