Healthcare Provider Details

I. General information

NPI: 1437432218
Provider Name (Legal Business Name): MORELLA E BOMBARDINI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2011
Last Update Date: 03/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3554 ROUND BARN BLVD
SANTA ROSA CA
95403-0929
US

IV. Provider business mailing address

2480 VINEYARD RD
NOVATO CA
94947-3601
US

V. Phone/Fax

Practice location:
  • Phone: 707-571-3987
  • Fax:
Mailing address:
  • Phone: 415-577-4018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number24339
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number24339
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: