Individual
MRS. DESIREE RENEE BONOMO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PAC
Contact information
Practice address
5475 WALNUT AVE, CHINO, CA 91710-2609
(909) 591-6444
Mailing address
5475 WALNUT AVE, CHINO, CA 91710-2609
(909) 591-6444
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA21269
CA
Other
Enumeration date
10/08/2010
Last updated
09/14/2011
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