Individual
MR. JOHN MARK CARLOS BONAGUA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
AGNP
Contact information
Practice address
612 ALLERTON AVE, BRONX, NY 10467-7404
(718) 519-4029
Mailing address
612 ALLERTON AVENUE, BRONX, NY 10467
(718) 519-4000
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
308120
NY
Other
Enumeration date
07/31/2017
Last updated
09/11/2017
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