Provider Demographics
NPI:1639653470
Name:BONNEGUE, PASCALE
Entity Type:Individual
Prefix:
First Name:PASCALE
Middle Name:
Last Name:BONNEGUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1684 FOREST LAKES CIR APT C
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33406-5764
Mailing Address - Country:US
Mailing Address - Phone:561-507-0174
Mailing Address - Fax:561-277-0833
Practice Address - Street 1:213 S CONGRESS AVE
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3823
Practice Address - Country:US
Practice Address - Phone:561-471-1688
Practice Address - Fax:561-881-0972
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL017269100Medicaid