Provider Demographics
NPI:1417357815
Name:DONGALLO, JONI
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:
Last Name:DONGALLO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JONI
Other - Middle Name:
Other - Last Name:DONGALLO-SYKES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:197 ANCHOR DR
Mailing Address - Street 2:
Mailing Address - City:BAY POINT
Mailing Address - State:CA
Mailing Address - Zip Code:94565-3068
Mailing Address - Country:US
Mailing Address - Phone:925-698-1152
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4301
Practice Address - Country:US
Practice Address - Phone:510-642-6891
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA735313163W00000X, 163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care