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NPI Code Detail

MEDICARE: BONNIE J GAINER M.D.

MEDICARE: BONNIE J GAINER 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
1174400000XSpecialistG55764CA
2207RI0011XInterventional Cardiology PhysicianG55764CA
3207RC0000XCardiovascular Disease PhysicianG55764CA

Other Identifiers

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

General Provider Information

NPI Number : 1972592319
Entity Type Code : Individual
Provider Name (Legal Business Name) : BONNIE J GAINER M.D.
Provider Business Mailing Address
First Line : 415 OLD NEWPORT BLVD
Second Line : SUITE 200
City : NEWPORT BEACH
State : CA
Zip : 92663-4248
Country : US
Telephone Number : 949-548-9611
Fax Number : 949-548-9958
Provider Business Practice Location Address
First Line : 415 OLD NEWPORT BLVD
Second Line : SUITE 200
City : NEWPORT BEACH
State : CA
Zip : 92663-4248
Country : US
Telephone Number : 949-548-9611
Fax Number : 949-548-9958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/18/2005
Last Update Date : 02/18/2020

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Directions to “ BONNIE J GAINER M.D.” Practice Location

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