Provider Demographics
NPI:1891181673
Name:BOGOMOLNY, RENEE FINE (DC)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:FINE
Last Name:BOGOMOLNY
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:JANE
Other - Last Name:FINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DC
Mailing Address - Street 1:4624 MALEZA PL
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4721
Mailing Address - Country:US
Mailing Address - Phone:310-844-5502
Mailing Address - Fax:
Practice Address - Street 1:2812 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2476
Practice Address - Country:US
Practice Address - Phone:310-488-7277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-08
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33231111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor