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General NPI Number Information
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NPI Number | 1134612013
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Entity Type | Individual
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Provider Name | MILDREDE BONGLACK MD
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Gender | Female
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Dates
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Enumeration Date | 06/14/2018
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Last Update Date | 10/16/2025
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Provider Practice Location Address
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Address Line | 797 W CHILDS AVE
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City | MERCED
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State | CA
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Zip | 95341-6805
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Country | US
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Telephone | 209-384-6498
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Fax | 209-359-2045
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Provider Business Mailing Address
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Address Line | 797 W CHILDS AVE
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City | MERCED
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State | CA
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Zip | 95341-6805
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VF0040X
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Taxonomy Name | Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
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License Number | A204492
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 35.144536
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | R-11323
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License Number State | IA
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Taxonomy #4
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 204492
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License Number State | CA
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