Basic Information
| Provider Information | |||||||||
| NPI: | 1265405096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DATTEL | ||||||||
| FirstName: | BONNIE | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6272 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931606272 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058980258 | ||||||||
| FaxNumber: | 8058982048 | ||||||||
| Practice Location | |||||||||
| Address1: | 316 W JUNIPERO ST | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931054305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8058980258 | ||||||||
| FaxNumber: | 8058982048 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2006 | ||||||||
| LastUpdateDate: | 06/08/2015 | ||||||||
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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 | 207VM0101X | 0101048500 | VA | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine | 207V00000X | 0101048500 | VA | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | PAR | 01 | VA | VIRGINIA HEALTH NETWORK | OTHER | PAR | 01 | VA | CORVEL/CORCARE | OTHER | PAR | 01 | VA | FIRST HEALTH COMMERCIAL/SOUTHERN HEALTH/COVENTRY | OTHER | 227480 | 01 | VA | UHC/MAMSI | OTHER | 14051 | 01 | VA | SENTARA OPTIMA | OTHER | 092616 | 01 | VA | ANTHEM | OTHER | 890595T | 05 | NC | MEDICAID | PAR | 01 | VA | VIRGINIA PREMIER HEALTH | OTHER | PAR | 01 | VA | AETNA | OTHER | PAR | 01 | VA | MULTIPLAN | OTHER | PAR | 01 | VA | CIGNA | OTHER | PAR | 01 | VA | USA MANAGED CARE | OTHER | -010 | 01 | VA | TRICARE/CHAMPUS | OTHER | G43784 | 01 | CA | MEDICAL LICENSE | OTHER | 006259995 | 05 | VA | MEDICAID | 0595T | 01 | NC | BC/BS | OTHER |