Basic Information
| Provider Information | |||||||||
| NPI: | 1134733058 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BONDAR | ||||||||
| FirstName: | SYDNEY | ||||||||
| MiddleName: | ROSE | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4080 PEDLEY RD SPC 186 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925092850 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4108300414 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1207 E FRUIT ST | ||||||||
| Address2: | |||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927014296 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7149539373 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2020 | ||||||||
| LastUpdateDate: | 09/25/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/25/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 8081 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 120060 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.