Basic Information
| Provider Information | |||||||||
| NPI: | 1902886393 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONGARD | ||||||||
| FirstName: | FREDERIC | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21840 NORMANDIE AVE | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102225189 | ||||||||
| FaxNumber: | 3107826786 | ||||||||
| Practice Location | |||||||||
| Address1: | 21840 S NORMANDIE AVE | ||||||||
| Address2: | STE. 700 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905022047 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102225189 | ||||||||
| FaxNumber: | 3107826786 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/20/2006 | ||||||||
| LastUpdateDate: | 06/22/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0129X | G43307 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Vascular Surgery |
No ID Information.