Provider Demographics
NPI:1801985114
Name:GRIFFIN, BONNIE JEAN (PA)
Entity type:Individual
Prefix:
First Name:BONNIE
Middle Name:JEAN
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 PIRIE RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-3166
Mailing Address - Country:US
Mailing Address - Phone:805-646-7246
Mailing Address - Fax:805-646-8936
Practice Address - Street 1:117 PIRIE RD
Practice Address - Street 2:SUITE D
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-3166
Practice Address - Country:US
Practice Address - Phone:805-646-7246
Practice Address - Fax:805-646-8936
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16572363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA951683892OtherOTHER INSURANCE
CARHM18553HMedicaid
CARHM08608FMedicaid
CARHM08609FMedicaid
CAZZT40394FMedicaid
CAWPA16572AMedicare ID - Type UnspecifiedPPIN
CAWPA16572CMedicare ID - Type UnspecifiedPPIN
CAWPA16572GMedicare ID - Type UnspecifiedPPIN
CAZZT40394FMedicaid
CA951683892OtherOTHER INSURANCE
CAWPA16572HMedicare ID - Type UnspecifiedPPIN
CAWPA16572FMedicare ID - Type UnspecifiedPPIN
CARHM08609FMedicaid
CARHM08608FMedicaid