Healthcare Provider Details

I. General information

NPI: 1962531269
Provider Name (Legal Business Name): TWINKLE JOSE MOOTHEDAN RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2105 FOREST AVE
SAN JOSE CA
95128-1425
US

IV. Provider business mailing address

1063 MORSE AVE APT 10-105
SUNNYVALE CA
94089-4619
US

V. Phone/Fax

Practice location:
  • Phone: 408-947-2516
  • Fax:
Mailing address:
  • Phone: 408-332-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number672485
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: