Individual
JULIA BONFESSUTO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
161 WATERDAM RD APT 120, CANONSBURG, PA 15317-2572
(412) 359-8900
(412) 359-8977
Mailing address
161 WATERDAM RD APT 120, CANONSBURG, PA 15317-2572
(412) 359-8900
(412) 359-8977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MA061321
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103742613
—
PA
01
—
15717611
CAQH
—
Enumeration date
12/17/2019
Last updated
07/03/2024
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