Provider Demographics
NPI:1801648977
Name:MATE, BONGOFA PATRICK
Entity type:Individual
Prefix:
First Name:BONGOFA
Middle Name:PATRICK
Last Name:MATE
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 1:138 PORTSIDE CT
Mailing Address - Street 2:
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-2431
Mailing Address - Country:US
Mailing Address - Phone:267-902-1606
Mailing Address - Fax:
Practice Address - Street 1:138 PORTSIDE CT
Practice Address - Street 2:
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-2431
Practice Address - Country:US
Practice Address - Phone:267-902-1606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPN2885519164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse