Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC28772 | CA |
NPI | 1083766869 |
---|---|
Provider Name | Dr. Frank Elizarde Bongolan JR. |
First Address | Danville, CA 94526-0596 |
Second Address | Danville, CA 94526-1848 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 28/12/2011 |