Healthcare Provider Details

I. General information

NPI: 1366682767
Provider Name (Legal Business Name): BERNADETTE TERESA ANSOLABEHERE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2009
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 OCONNOR DR STE 200
SAN JOSE CA
95128-1632
US

IV. Provider business mailing address

455 OCONNOR DR STE 250
SAN JOSE CA
95128-1644
US

V. Phone/Fax

Practice location:
  • Phone: 408-283-7676
  • Fax: 408-283-7646
Mailing address:
  • Phone: 408-283-7767
  • Fax: 408-283-7608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA103954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: