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Individual
JONVANNI BONGOLAN
Active
Individual
JONVANNI BONGOLAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
624546
CA
363LF0000X
Family Nurse Practitioner
Primary
19774
CA
Other
Enumeration date
09/02/2010
Last updated
12/07/2010
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