Healthcare Provider Details

I. General information

NPI: 1205071859
Provider Name (Legal Business Name): MICHAEL NORMAN BENTLEY RDMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2008
Last Update Date: 12/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 FRANCISCAN CT #5
FREMONT CA
94539-7073
US

IV. Provider business mailing address

320 FRANCISCAN CT #5
FREMONT CA
94539-7073
US

V. Phone/Fax

Practice location:
  • Phone: 510-683-8559
  • Fax:
Mailing address:
  • Phone: 510-683-8559
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2471S1302X
TaxonomySonography Radiologic Technologist
License Number128920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: