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General NPI Number Information
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NPI Number | 1720700503
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Entity Type | Individual
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Provider Name | DENISE BEDOLLA FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2022
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Last Update Date | 01/15/2023
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Provider Practice Location Address
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Address Line | 800 S MAIN ST
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City | CORONA
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State | CA
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Zip | 92882-3420
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Country | US
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Telephone | 951-737-4343
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Fax |
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Provider Business Mailing Address
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Address Line | 36721 AMATEUR WAY
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City | BEAUMONT
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State | CA
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Zip | 92223-8118
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Country | US
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Telephone | 760-792-3142
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95022554
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License Number State | CA
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