Individual
MR. RANDY PATIO BONOTANO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 SAN DIEGO AVE, DALY CITY, CA 94014-1038
(415) 203-0749
Mailing address
109 SAN DIEGO AVE, DALY CITY, CA 94014-1038
(415) 203-0749
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
041931939
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
IT-04-19-31939
—
CA
Enumeration date
08/27/2019
Last updated
08/27/2019
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