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General NPI Number Information
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NPI Number | 1497155683
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Entity Type | Individual
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Provider Name | JENNIFER BENTLEY PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/26/2014
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Last Update Date | 01/03/2022
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Provider Practice Location Address
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Address Line | 170 COLUMBUS AVE STE 110
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City | SAN FRANCISCO
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State | CA
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Zip | 94133-5160
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Country | US
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Telephone | 415-965-8050
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Fax | 415-965-7678
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Provider Business Mailing Address
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Address Line | 3400 DATA DR
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City | RANCHO CORDOVA
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State | CA
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Zip | 95670-7956
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Country | US
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Telephone |
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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 | 0110004671
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License Number State | VA
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