Healthcare Provider Details

I. General information

NPI: 1164929386
Provider Name (Legal Business Name): TIMOTHY M NARDINE MD MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 03/08/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2530 BERRYESSA RD STE 218
SAN JOSE CA
95132-2903
US

IV. Provider business mailing address

2530 BERRYESSA RD STE 218
SAN JOSE CA
95132-2903
US

V. Phone/Fax

Practice location:
  • Phone: 408-356-4959
  • Fax: 408-358-8692
Mailing address:
  • Phone: 408-356-4959
  • Fax: 408-358-8692

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: TIMOTHY NARDINE
Title or Position: PHYSICIAN
Credential: MD
Phone: 346-396-3480