Provider Demographics
NPI:1700628047
Name:BONNER, CELENA M (MS, RD)
Entity type:Individual
Prefix:
First Name:CELENA
Middle Name:M
Last Name:BONNER
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2241 OCCIDENTAL RD
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94545-2333
Mailing Address - Country:US
Mailing Address - Phone:510-290-8705
Mailing Address - Fax:
Practice Address - Street 1:2241 OCCIDENTAL RD
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94545-2333
Practice Address - Country:US
Practice Address - Phone:510-290-8705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-08
Last Update Date:2024-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered