Provider Demographics
NPI:1851476576
Name:BONIFACIO, CHRISTINE LEIGH (HEALTH SERVICES TECH)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:LEIGH
Last Name:BONIFACIO
Suffix:
Gender:F
Credentials:HEALTH SERVICES TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USCG HQ COMDT (CG-1122)
Mailing Address - Street 2:2100 SECOND ST., SW.
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20593-0001
Mailing Address - Country:US
Mailing Address - Phone:202-475-5181
Mailing Address - Fax:202-475-5909
Practice Address - Street 1:USCG HQ COMDT (CG-1122)
Practice Address - Street 2:2100 SECOND ST., SW.
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20593-0001
Practice Address - Country:US
Practice Address - Phone:202-475-5181
Practice Address - Fax:202-475-5909
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman