Individual
BONTAYA CALVIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CERTIFIED HAIRLOSS
Taxonomy
Speciality
Code
Description
License number
State
1744P3200X
Prosthetics Case Management
Primary
157804
TN
224P00000X
Prosthetist
157804
TN
Other
Enumeration date
08/14/2020
Last updated
08/14/2020
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