Healthcare Provider Details

I. General information

NPI: 1144943663
Provider Name (Legal Business Name): BONA PARLINDUNGAN LVN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2022
Last Update Date: 09/20/2022
Certification Date: 09/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 DRESDEN DR
LINCOLN CA
95648-8803
US

IV. Provider business mailing address

4753 PISMO BEACH DR
ANTELOPE CA
95843-4325
US

V. Phone/Fax

Practice location:
  • Phone: 916-543-5400
  • Fax:
Mailing address:
  • Phone: 916-472-8211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number278267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: