Healthcare Provider Details

I. General information

NPI: 1952234627
Provider Name (Legal Business Name): CLAUDINE BERNADETTE MADAMBA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CLAUDINE MADAMBA

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1259 EL CAMINO REAL # 169
MENLO PARK CA
94025-4208
US

IV. Provider business mailing address

1259 EL CAMINO REAL # 169
MENLO PARK CA
94025-4208
US

V. Phone/Fax

Practice location:
  • Phone: 510-463-1516
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95029506
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: