Healthcare Provider Details

I. General information

NPI: 1952441297
Provider Name (Legal Business Name): NICOLE SORRENTINO BURNHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2577 SAMARITAN DR STE 810
SAN JOSE CA
95124-4100
US

IV. Provider business mailing address

2350 W EL CAMINO REAL 2ND FLOOR
MOUNTAIN VIEW CA
94040-6201
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-0133
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21691
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number010690
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: