Provider Demographics
NPI:1982750394
Name:BOMGAARS, MONA RUTH (MD)
Entity type:Individual
Prefix:
First Name:MONA
Middle Name:RUTH
Last Name:BOMGAARS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 AINAPO ST
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1050
Mailing Address - Country:US
Mailing Address - Phone:808-394-0459
Mailing Address - Fax:
Practice Address - Street 1:712 AINAPO ST
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96825-1050
Practice Address - Country:US
Practice Address - Phone:808-394-0459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI7596207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine