Healthcare Provider Details

I. General information

NPI: 1588721385
Provider Name (Legal Business Name): MARILOU VENDIOLA KOKMEYER CRNA, MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARILOU P VENDIOLA KOKMEYER CRNA, MS

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 12/15/2021
Certification Date: 12/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 HOSPITAL PARKWAY DEPARTMENT OF ANESTHESIA
SAN JOSE CA
95119
US

IV. Provider business mailing address

1367 FERREL CT
SAN JOSE CA
95132-2371
US

V. Phone/Fax

Practice location:
  • Phone: 408-972-7133
  • Fax: 408-972-7662
Mailing address:
  • Phone: 408-272-1190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number429197
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: