Healthcare Provider Details

I. General information

NPI: 1245343573
Provider Name (Legal Business Name): BEVORLY FHAMORE CAIN-BERK N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: BEVORLY FHAMORE CAIN N.P.

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 12/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4105 TIMBERLINE DR
SAN JOSE CA
95121-1033
US

IV. Provider business mailing address

4105 TIMBERLINE DR
SAN JOSE CA
95121-1033
US

V. Phone/Fax

Practice location:
  • Phone: 408-620-1166
  • Fax: 408-912-5340
Mailing address:
  • Phone: 408-620-1166
  • Fax: 408-912-5340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN614337
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberNP 14109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: