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General NPI Number Information
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NPI Number | 1679100911
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Entity Type | Organization
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Legal Business Name | BENDITO MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/28/2022
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Provider Practice Location Address
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Address Line | 1780 E HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4618
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Country | US
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Telephone | 909-402-4601
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Fax | 909-402-4609
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Provider Business Mailing Address
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Address Line | 1780 E HIGHLAND AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-4618
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Country | US
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Telephone | 818-618-3728
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Fax | 818-888-3775
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Authorized Official
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Title or Position | MD/CEO
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Name | CHIOMA KALU
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Credential | MD
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Telephone | 909-402-4601
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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