Provider Demographics
NPI:1811141393
Name:BONGALON, MARIA ANNIE SHANER SUMAYAO (DC)
Entity type:Individual
Prefix:
First Name:MARIA ANNIE SHANER
Middle Name:SUMAYAO
Last Name:BONGALON
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1214 APOLLO WAY
Mailing Address - Street 2:SUITE 401
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5413
Mailing Address - Country:US
Mailing Address - Phone:408-733-1032
Mailing Address - Fax:408-733-0000
Practice Address - Street 1:1214 APOLLO WAY
Practice Address - Street 2:SUITE 401
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5413
Practice Address - Country:US
Practice Address - Phone:408-733-1032
Practice Address - Fax:408-733-0000
Is Sole Proprietor?:No
Enumeration Date:2008-11-10
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31001111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitation