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General NPI Number Information
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NPI Number | 1366619546
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Entity Type | Individual
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Provider Name | NICOLE CHRISTINE BENDEMIRE MPA, PA-C
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Gender | Female
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Dates
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Enumeration Date | 05/15/2008
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Last Update Date | 05/15/2008
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Provider Practice Location Address
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Address Line | 2050 CLARMAR WAY
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City | SAN JOSE
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State | CA
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Zip | 95128-1704
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Country | US
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Telephone | 408-294-7551
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Fax |
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Provider Business Mailing Address
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Address Line | 909 MARINA VILLAGE PKWY # 223
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City | ALAMEDA
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State | CA
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Zip | 94501-1048
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Country | US
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Telephone | 510-402-8568
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 19709
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License Number State | CA
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