Basic Information
| Provider Information | |||||||||
| NPI: | 1558385682 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HOOES | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CHACON | ||||||||
| OtherFirstName: | BONNIE | ||||||||
| OtherMiddleName: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 14271 JEFFREY RD PMB #43 | ||||||||
| Address2: | |||||||||
| City: | IRVINE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926203405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495155440 | ||||||||
| FaxNumber: | 9495155444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2183 FAIRVIEW RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | COSTA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926275671 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9495155440 | ||||||||
| FaxNumber: | 9495155444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 07/31/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.