Provider Demographics
NPI:1386901775
Name:BOKALO, ADRIANNA ZENIA (MED)
Entity type:Individual
Prefix:MS
First Name:ADRIANNA
Middle Name:ZENIA
Last Name:BOKALO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 OCEAN PALM WAY
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-8711
Mailing Address - Country:US
Mailing Address - Phone:215-284-3845
Mailing Address - Fax:
Practice Address - Street 1:788 OCEAN PALM WAY
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-8711
Practice Address - Country:US
Practice Address - Phone:215-284-3845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-23
Last Update Date:2013-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other