Individual
CHARLLIE BONGOLAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
8700 BEVERLY BLVD, WEST HOLLYWOOD, CA 90048-1804
(310) 423-4655
Mailing address
17036 KIRK VIEW DR, HACIENDA HEIGHTS, CA 91745-6704
(626) 347-2152
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95022864
CA
Other
Enumeration date
03/15/2025
Last updated
03/15/2025
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