Individual
DR. JEFFREY FRANK BONADIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4680 TARANTELLA LN, SAN DIEGO, CA 92130-2464
(858) 525-1977
Mailing address
4680 TARANTELLA LN, SAN DIEGO, CA 92130-2464
(858) 525-1977
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
G87022
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G870220
BLUE SHIELD
CA
05
—
00G870220
—
CA
01
—
WG87022A
MEDICARE PTAN
CA
Enumeration date
02/04/2007
Last updated
05/05/2009
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