MILDREDE N BONGLACK MD - NPI 1134612013 - Obstetrics & Gynecology in Fresno, CA

Q: What is Mildrede Bonglack's NPI number?

The NPI number for Mildrede Bonglack is 1134612013. It was assigned to this individual provider in the NPPES registry on June 14, 2018.

Q: What is Mildrede Bonglack's specialty?

The primary specialty registered for this NPI is Obstetrics & Gynecology, specializing in Urogynecology and Reconstructive Pelvic Surgery, with taxonomy code 207VF0040X.

Q: When was this NPI record last updated?

The NPPES record for Mildrede Bonglack was last updated on January 2, 2026. NPI Profile syncs with the weekly NPPES data releases published by CMS.

On this page

About Mildrede N Bonglack Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MILDREDE N BONGLACK MD (NPI 1134612013) is an individual urogynecology and reconstructive pelvic surgery provider in Fresno, California, licensed in California (A204492) and active in the NPI registry since June 2018. She is enrolled in Medicare PECOS, maintains a secondary practice location in Merced, and is a graduate of University Of Cincinnati College Of Medicine (2018).

NPPES Registry Identity

NPI1134612013

Entity TypeIndividualFemale

Primary Taxonomy207VF0040X

Provider Legal NameMILDREDE N BONGLACKCredential: MD

Location Address2210 E ILLINOIS AVE STE 408Fresno, CA 93701-2184

Mailing Address2625 E Divisadero StFresno, CA 93721-1431 · (559) 453-5200 · Fax (559) 453-5233

Phone(559) 443-2694

Fax(559) 443-2696

Sole ProprietorNo

Medical School CMSUniversity Of Cincinnati College Of MedicineGraduated 2018

Enumeration DateJune 14, 2018

Last NPPES UpdateJanuary 2, 20262 updates tracked since enumeration

NPPES CertifiedJanuary 2, 2026

✔ NPI 1134612013 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyObstetrics & Gynecology · Urogynecology and Reconstructive Pelvic SurgeryAllopathic & Osteopathic Physicians

Taxonomy Code207VF0040X

License✔ Licensed in CA · A204492

Definition

A subspecialist in Urogynecology and Reconstructive Pelvic Surgery is a physician in Urology or Obstetrics and Gynecology who, by virtue of education and training, is prepared to provide consultation and comprehensive management of women with complex benign pelvic conditions, lower urinary tract disorders, and pelvic floor dysfunction. Comprehensive management includes those diagnostic and therapeutic procedures necessary for the total care of the patient with these conditions and complications resulting from them.

Also ListedObstetrics & GynecologyTaxonomy 207V00000X · License A204492 (CA)

2210 E ILLINOIS AVE STE 408, Fresno, CA 93701

Open in Google Maps ↗

Secondary Practice Location 1

Location 1797 W Childs AveMerced, CA 95341-6805 · Phone (209) 384-6498 · Fax (209) 359-2045

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mildrede N Bonglack Md is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7719233626

PECOS Enrollment IDI20251014003584

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 93701 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$133.94 typical visit price

range $58.87 – $176.60

Typical copayment $33.48 (range $14.71 – $44.15)

Most-billed visit code 99204

Established Patient

$73.16 typical visit price

range $19.28 – $144.60

Typical copayment $18.29 (range $4.82 – $36.15)

Most-billed visit code 99213

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. MELANIE ELAYNE KING MSN, RN, NP-C

Nurse Practitioner