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Individual

ANGELICA PENAGOS BOLIVAR

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
3420 94TH ST, FLUSHING, NY 11372-3824
(718) 424-9031
Mailing address
102 PECONIC CT, MELVILLE, NY 11747-5305
(631) 742-6351

Taxonomy

Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
3783561
NY

Other

Enumeration date
12/05/2016
Last updated
12/05/2016
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