MEDICARE: JOHN BRIDENBECK CNIM, R. EEG. T

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
1	156F00000X	Technician/Technologist
2	246ZE0600X	Electroneurodiagnostic Specialist/Technologist	4184

General Provider Information

NPI Number	:	1902444714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN BRIDENBECK CNIM, R. EEG. T

Provider Business Mailing Address
First Line	:	2930 DOMINGO AVE STE 529
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94705-2454
Country	:	US
Telephone Number	:	971-226-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	8135 SARATOGA WAY
Second Line	:
City	:	EL DORADO HILLS
State	:	CA
Zip	:	95762-4590
Country	:	US
Telephone Number	:	971-226-6108
Fax Number	:	510-826-5898

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2019
Last Update Date	:	12/12/2022

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