Organization
BONAVENTURE F ENG MD INC
Active
Organization
BONAVENTURE F ENG MD INC
Active
Parent organization
BONAVENTURE F ENG MD INC
Organization subpart
Yes
Provider details
NPI number
Legal business name
BONAVENTURE F ENG MD INC
Authorized official
BONAVENTURE F ENG MD (OWNER)
(805) 497-0961
Entity
Organization
Contact information
Practice address
2230 LYNN RD, SUITE 104, THOUSAND OAKS, CA 91360-1901
(806) 497-0961
(806) 496-4818
Mailing address
2230 LYNN ROAD, SUITE 104, THOUSAND OAKS, CA 91360
(806) 497-0961
(806) 496-4818
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
G22291
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G222910
—
CA
Enumeration date
01/09/2007
Last updated
10/31/2012
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