Individual
MARK ANTHONY BAGASOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
770 N PLANO ST, PORTERVILLE, CA 93257-6329
(559) 793-5519
Mailing address
770 N PLANO ST, PORTERVILLE, CA 93257-6329
(559) 793-5519
Taxonomy
Speciality
Code
Description
License number
State
146N00000X
Basic Emergency Medical Technician
Primary
B15-10170
CA
Other
Enumeration date
10/22/2020
Last updated
10/22/2020
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