Individual
DR. BONNIE TEKLIN MOURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1520 SAN PABLO ST, SUITE 1000, LOS ANGELES, CA 90033-5310
(818) 952-3075
(818) 790-2215
Mailing address
PO BOX 31309, LOS ANGELES, CA 90031-0309
(818) 952-3075
(818) 790-2215
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
G061553
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1902846306
GROUP NPI
CA
01
—
GR0100430
GROUP MEDICAL
CA
01
—
W18762
GROUP MEDICARE
CA
Enumeration date
02/15/2006
Last updated
04/24/2012
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