LORENZO S. BONGOLAN, M.D
Medical Practice at Kennedy Blvd, Tampa, FL

License number
Florida ME27892
Category
Medical Practice
Type
Specialist
Owner
Name: DR. LORENZO SALVADOR BONGOLAN M.D.
Title: PHYSICIAN OWNER
Phone: (813) 873-8877
Address
Address
3424 W Kennedy Blvd, Tampa, FL 33609
National Provider ID: 1235294430
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Lorenzo S Bongolan MD

Tampa, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Lorenzo S. Bongolan, M.D., PA
Registration:
Mar 14, 1983
Addresses:
3424 W Kennedy Blvd, Tampa, FL 33609
9903 Lone Tree Ln, Tampa, FL 33618
State ID:
G27550
Business type:
Domestic for Profit Corporation
Managers:
Lorenzo S. Bongolan Medical Doctor, Principal, President, Director, Secretary, inactive,Anne Graff Manager, inactive
Agent:
Bongolan, Lorenzo S., M.d., Pa

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