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General NPI Number Information
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NPI Number | 1235955360
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Entity Type | Individual
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Provider Name | DAVID WILLIAM BODINE
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Gender | Male
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Dates
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Enumeration Date | 11/22/2024
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Last Update Date | 04/08/2025
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Provider Practice Location Address
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Address Line | 298 A BERNAL ROAD
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City | SAN JOSE
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State | CA
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Zip | 95119
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Country | US
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Telephone | 408-780-0755
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Fax | 408-956-6269
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Provider Business Mailing Address
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Address Line | 5740 CANNA LN UNIT B
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City | SAN JOSE
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State | CA
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Zip | 95124-6578
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Country | US
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Telephone | 408-833-3750
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 135343
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License Number State | CA
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