Individual
ANN LUCILLE BONFIGLIO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1517 MEADOW GROVE ST, MODESTO, CA 95355-1126
(209) 404-6961
Mailing address
1517 MEADOW GROVE ST, MODESTO, CA 95355-1126
(209) 404-6961
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
332261
CA
Other
Enumeration date
04/02/2013
Last updated
04/02/2013
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