Individual
DR. MICHAEL S BONGIOVANNI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
4060 4TH AVE, SUITE 630, SAN DIEGO, CA 92103-2116
(619) 299-3950
(619) 299-3951
Mailing address
4060 4TH AVE, SUITE 630, SAN DIEGO, CA 92103-2116
(619) 299-3950
(619) 299-3951
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
G59386
CA
207X00000X
Orthopaedic Surgery Physician
Primary
G59386
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G593860
—
CA
01
—
200042516
RR MEDICARE
CA
01
—
4858980001
CIGNA MEDICARE DMERC
CA
Enumeration date
03/01/2006
Last updated
01/14/2014
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