Healthcare Provider Details

I. General information

NPI: 1659611853
Provider Name (Legal Business Name): MARLENE BEDRICH RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2013
Last Update Date: 02/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE SUITE A-550
SAN FRANCISCO CA
94143-1222
US

IV. Provider business mailing address

11055 INTERNATIONAL DR
RANCHO CORDOVA CA
95670-6252
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-9069
  • Fax: 415-353-2392
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number412576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: