Teodulo Cruz Bonzon, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS19646 Issued in CA

Practice address

3013 Annita Dr
Glendale, CA 91206-1302

Phone

(818) 846-4469

NPI assigned

Sep 30, 2011

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Specialty

Clinical Social Worker

Education

Other, 1995

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Guadalupe Medical Group

  • Internal Medicine Physician
  • Los Angeles, CA
  • NPI 1053902734
  NPD Authorized official
• Levanta Counseling Servicess LLC

  • Mental Illness Community Based Residential Treatment Facility
  • Glendale, CA
  • NPI 1376917146
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577664000000",
    "number": "1497039192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9405",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912260405",
            "telephone_number": "818-846-4469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3013 ANNITA DR",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912061302",
            "telephone_number": "818-846-4469"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BONZON",
        "first_name": "TEODULO",
        "middle_name": "CRUZ",
        "name_prefix": "Mr.",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-09-30",
        "last_updated": "2019-12-30",
        "certification_date": "2019-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS19646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "Hubchart",
            "affiliation": "N",
            "endpointDescription": "HIPAAA compliant charting app",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "pdfs",
            "address_1": "3013 Annita Dr",
            "city": "Glendale",
            "state": "CA",
            "country_code": "US",
            "postal_code": "912061302",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Khaliun Boldoo
• Torieryn Boles-Armstrong
• Kirstie Bondoc
• Jennifer Bonilla
• Stephanie Bonilla
• Soonthorn Boonnoppornkul, BCBA
• Jennifer Rose Boozer, DO
• Brock Allen Borah, DC
• Charlotte Carolyn Michelle Bories
• Joseph Bornheimer Jr., M.D.

• Clinical Social Worker in Glendale, CA
• Providers in Glendale, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.