Healthcare Provider Details

I. General information

NPI: 1790254472
Provider Name (Legal Business Name): BERNADETTE THERESA O'NEILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/25/2018
Last Update Date: 11/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LAWRENCE EXPY
SANTA CLARA CA
95051-5173
US

IV. Provider business mailing address

7421 MILLER AVE
GILROY CA
95020-5509
US

V. Phone/Fax

Practice location:
  • Phone: 408-851-7020
  • Fax:
Mailing address:
  • Phone: 831-419-7112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number18045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: