Individual
MR. BONAR SOFIAN MANGUNSONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
25340 PARK AVE APT 6, LOMA LINDA, CA 92354
(909) 252-6481
Mailing address
25340 PARK AVE APT 6, LOMA LINDA, CA 92354-2339
(909) 252-6481
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
52249
CA
Other
Enumeration date
01/22/2015
Last updated
01/22/2015
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