Provider Demographics
NPI:1174120323
Name:BONGCAYAO, JAMES DAVID (MCC)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:BONGCAYAO
Suffix:
Gender:M
Credentials:MCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2420 KINCAID ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-3056
Mailing Address - Country:US
Mailing Address - Phone:541-501-3062
Mailing Address - Fax:
Practice Address - Street 1:2420 KINCAID ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-3056
Practice Address - Country:US
Practice Address - Phone:541-501-3062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-01
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator