Organization
MICHAEL S BONGIOVANNI MD INC
Active
Organization
MICHAEL S BONGIOVANNI MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL S BONGIOVANNI M.D. (PRESIDENT)
(619) 299-3950
Entity
Organization
Contact information
Practice address
4060 4TH AVE, SUITE 630, SAN DIEGO, CA 92103-2116
(619) 299-3950
(619) 299-3951
Mailing address
4060 4TH AVE, SUITE 630, SAN DIEGO, CA 92103-2116
(619) 299-3950
(619) 299-3951
Taxonomy
Speciality
Code
Description
License number
State
207XX0801X
Orthopaedic Trauma Physician
Primary
G59386
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G593860
—
CA
01
—
200042516
RR MEDICARE
CA
Enumeration date
01/05/2009
Last updated
04/16/2013
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