Organization
BONITA CARDIOVASCULAR MED GRP INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LORENZO GONZALEZ LAVIN MD (PRESIDENT)
(619) 267-6922
Entity
Organization
Contact information
Practice address
3916 PALM DRIVE, BONITA, CA 91902
(619) 267-6922
(619) 267-2013
Mailing address
PO BOX 1534, BONITA, CA 91908-1534
(619) 267-6922
(619) 267-2013
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A30915
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A30951
—
CA
Enumeration date
12/05/2006
Last updated
04/04/2013
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