Individual
BONIFACIO TAN AGUILERA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
307 TERLYN DRIVE, JOHNSTOWN, PA 15904
(814) 467-6378
Mailing address
307 TERLYN DRIVE, JOHNSTOWN, PA 15904
(814) 467-6378
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17585E
PA
Other
Enumeration date
02/01/2012
Last updated
02/01/2012
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