Provider Demographics
NPI:1598364812
Name:BONDARENKO, ROSTISLAV
Entity Type:Individual
Prefix:
First Name:ROSTISLAV
Middle Name:
Last Name:BONDARENKO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 FRANCIS AVE
Mailing Address - Street 2:
Mailing Address - City:WALLA WALLA
Mailing Address - State:WA
Mailing Address - Zip Code:99362-2443
Mailing Address - Country:US
Mailing Address - Phone:509-200-3195
Mailing Address - Fax:
Practice Address - Street 1:611 FRANCIS AVE
Practice Address - Street 2:
Practice Address - City:WALLA WALLA
Practice Address - State:WA
Practice Address - Zip Code:99362-2443
Practice Address - Country:US
Practice Address - Phone:509-200-3195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA171R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171R00000XOther Service ProvidersInterpreter