BONAR SOFIAN MANGUNSONG

LOMA LINDA, CA
NPI1437548880
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363A00000X Physician Assistant
(Licence: CA  52249)
Enumeration Date2015-01-22
Last Update Date2015-01-22
Business Address
Mr. BONAR SOFIAN MANGUNSONG
25340 PARK AVE APT 6
LOMA LINDA, CA 92354
Phone number: 909-252-6481
Mailing Address
Mr. BONAR SOFIAN MANGUNSONG
25340 PARK AVE APT 6
LOMA LINDA, CA 92354-2339
Phone number: 909-252-6481
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