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General NPI Number Information
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NPI Number | 1841787991
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Entity Type | Individual
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Provider Name | MARIA BANDOOKWALA FNP
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Gender | Female
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Dates
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Enumeration Date | 04/15/2018
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Last Update Date | 08/13/2022
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Provider Practice Location Address
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Address Line | 3320 TULLY RD STE 1
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City | MODESTO
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State | CA
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Zip | 95350-0800
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Country | US
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Telephone | 209-550-5200
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Fax |
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Provider Business Mailing Address
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Address Line | 2449 KASLIN DR
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City | MODESTO
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State | CA
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Zip | 95355-7906
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Country | US
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Telephone | 832-279-1989
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 95016458
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License Number State | CA
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