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NPI Code Detail

MEDICARE: ROSALIA BONGWA

MEDICARE:   ROSALIA  BONGWA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistRPH 46582CA

General Provider Information

NPI Number : 1740635184
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSALIA BONGWA
Provider Business Mailing Address
First Line : 1701 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-5803
Country : US
Telephone Number : 323-731-9247
Fax Number :
Provider Business Practice Location Address
First Line : 1701 S WESTERN AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90006-5803
Country : US
Telephone Number : 323-731-9247
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/03/2016
Last Update Date : 05/03/2016

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Directions to “ ROSALIA BONGWA ” Practice Location

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