Healthcare Provider Details

I. General information

NPI: 1336508506
Provider Name (Legal Business Name): BRENDA L. BEBAL FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/17/2016
Last Update Date: 12/12/2024
Certification Date: 12/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10737 CAMINO RUIZ; STE 235 OPERATION SAMAHAN HEALTH CLINIC
SAN DIEGO CA
92126
US

IV. Provider business mailing address

10737 CAMINO RUIZ; STE 235 OPERATION SAMAHAN HEALTH CLINIC
SAN DIEGO CA
92126
US

V. Phone/Fax

Practice location:
  • Phone: 858-578-4220
  • Fax: 858-578-4417
Mailing address:
  • Phone: 858-578-4220
  • Fax: 858-578-4417

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95003948
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: