Individual
RICHARD STEVEN BODANESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2328 COALINGA CT, CLAREMONT, CA 91711-1753
(909) 489-1922
Mailing address
PO BOX 813, CLAREMONT, CA 91711-0813
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G54952
CA
Other
Enumeration date
05/17/2012
Last updated
05/17/2012
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