Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208D00000X | General Practice Physician | A136255 | CA |
NPI | 1033403647 |
---|---|
Provider Name | Christine Lori Rongey |
First Address | Modesto, CA 95357-6768 |
Second Address | Modesto, CA 95356-9262 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2011 |
Last Update Date | 23/12/2021 |