Individual
JOHN JAYSON LOPEZ BONGGA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
400 N PEPPER AVE, COLTON, CA 92324-1801
(909) 580-2440
Mailing address
11755 MALAGA DR, UNIT 1165, RANCHO CUCAMONGA, CA 91730-7224
(909) 851-3067
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
95000665
CA
Other
Enumeration date
08/04/2016
Last updated
12/06/2021
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