Individual
MR. BONN DEMETRIO MISO HIDALGO III
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4760 SEPULVEDA BLVD, CULVER CITY, CA 90230-4820
(310) 390-6612
(310) 398-5690
Mailing address
15259 ADAMS DR, BALDWIN PARK, CA 91706-3404
(626) 991-4385
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
109311
CA
104100000X
Social Worker
Primary
137368
CA
1041C0700X
Clinical Social Worker
—
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
08/07/2021
Last updated
03/04/2026
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