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General NPI Number Information
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NPI Number | 1952441297
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Entity Type | Individual
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Provider Name | NICOLE SORRENTINO BURNHAM PA
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Gender | Female
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Dates
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Enumeration Date | 02/07/2007
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 2577 SAMARITAN DR STE 810
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City | SAN JOSE
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State | CA
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Zip | 95124-4100
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Country | US
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Telephone | 408-358-0133
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Fax |
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Provider Business Mailing Address
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Address Line | 2350 W EL CAMINO REAL 2ND FLOOR
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-6201
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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 | PA21691
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 010690
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License Number State | NY
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