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NPI Code Detail

MEDICARE: MR. NOAH SETH BONNEVILLE PMHNP-BC

MEDICARE: MR. NOAH SETH BONNEVILLE PMHNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101Y00000XCounselor
2363L00000XNurse Practitioner95021678CA
3363LP0808XPsychiatric/Mental Health Nurse Practitioner95021678CA

General Provider Information

NPI Number : 1255460952
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NOAH SETH BONNEVILLE PMHNP-BC
Provider Business Mailing Address
First Line : 4633 OLD IRONSIDES DR STE 304
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-1846
Country : US
Telephone Number : 323-205-7088
Fax Number :
Provider Business Practice Location Address
First Line : 4633 OLD IRONSIDES DR STE 304
Second Line :
City : SANTA CLARA
State : CA
Zip : 95054-1846
Country : US
Telephone Number : 323-205-7088
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2007
Last Update Date : 06/27/2025

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Directions to “ MR. NOAH SETH BONNEVILLE PMHNP-BC” Practice Location

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