Individual
MILDREDE N BONGLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2210 E ILLINOIS AVE STE 408, FRESNO, CA 93701-2184
(559) 443-2694
(559) 443-2696
Mailing address
2625 E DIVISADERO ST, FRESNO, CA 93721-1431
(559) 453-5200
(559) 453-5233
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
A204492
CA
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
A204492
CA
Other
Enumeration date
06/14/2018
Last updated
01/02/2026
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