Individual
FREDRICK NYABAYO BOGONKO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 VINEYARD RD APT 1623, ROSEVILLE, CA 95747-9132
(626) 272-6174
Mailing address
1601 VINEYARD RD APT 1623, ROSEVILLE, CA 95747-9132
(626) 272-6174
Taxonomy
Speciality
Code
Description
License number
State
163WM0705X
Medical-Surgical Registered Nurse
Primary
812434
CA
Other
Enumeration date
05/27/2021
Last updated
05/27/2021
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