Individual
BONNIE CONNOLLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
DEPT LA 21069, PASADENA, CA 91185-1069
(714) 628-3211
(714) 639-0593
Mailing address
DEPT LA 21069, PASADENA, CA 91185-1069
(714) 628-3211
(714) 639-0593
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
BC082902
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4597443
—
MI
Enumeration date
04/14/2006
Last updated
12/13/2011
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