Provider Demographics
NPI:1528662913
Name:BONGIORNO, KIMBERLY BELGICA (RDMS)
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:BELGICA
Last Name:BONGIORNO
Suffix:
Gender:F
Credentials:RDMS
Other - Prefix:MRS
Other - First Name:KIMBERLY
Other - Middle Name:BELGICA
Other - Last Name:CHARUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10745 KITTERING TRL
Mailing Address - Street 2:
Mailing Address - City:HASLET
Mailing Address - State:TX
Mailing Address - Zip Code:76052
Mailing Address - Country:US
Mailing Address - Phone:214-609-4978
Mailing Address - Fax:
Practice Address - Street 1:10745 KITTERING TRL
Practice Address - Street 2:
Practice Address - City:HASLET
Practice Address - State:TX
Practice Address - Zip Code:76052
Practice Address - Country:US
Practice Address - Phone:214-609-4978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2013632085U0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound