Individual
MS. SUSAN BONFIGLIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 200-5325
(602) 200-5335
Mailing address
4212 N 16TH ST, PHOENIX, AZ 85016-5319
(602) 200-5325
(602) 200-5335
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
383
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
97375578
—
CO
Enumeration date
01/05/2006
Last updated
03/19/2008
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