Ssennyamantono, Bonifasiyo K.

Ssennyamantono, Bonifasiyo K. is an individual health care provider with primary practice located at 10815 W Mcdowell Rd Suite 202, Avondale AZ 85392-5007. He recently has only one registered license in Allopathic & Osteopathic Physicians / Cardiovascular Disease, which is considered as his primary health care specialty. Ssennyamantono, Bonifasiyo K. can be contacted via phone (623) 433-0202.

Contact Information

Primary practice address
10815 W Mcdowell Rd Suite 202 Avondale AZ 85392-5007
Phone: (623) 433-0202
Fax: (623) 433-0206
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Cardiovascular Disease 207RC0000X 35788 Arizona

Profile Details

NPI number 1902813678
LBN Legal business name Ssennyamantono, Bonifasiyo K.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Aug 2nd, 2006
Last updated Apr 22nd, 2019 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1902813678 NPPES
Arizona MEDICAID 129134

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