Individual
BOMNARA DEGROOT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1444 FLORIDA AVE STE 202, MODESTO, CA 95350-4400
(209) 524-1264
Mailing address
1444 FLORIDA AVE STE 202, MODESTO, CA 95350-4400
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
95012814
CA
363LF0000X
Family Nurse Practitioner
Primary
95012814
CA
Other
Enumeration date
10/09/2019
Last updated
09/02/2020
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