MEDICARE: BERNARDITA MENDEZ ROE NP

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	363LA2200X	Adult Health Nurse Practitioner	515952	CA
2	363LA2200X	Adult Health Nurse Practitioner	13708	CA

General Provider Information

NPI Number	:	1912268145
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARDITA MENDEZ ROE NP

Provider Business Mailing Address
First Line	:	2500 MOWRY AVE STE 255
Second Line	:
City	:	FREMONT
State	:	CA
Zip	:	94538-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6236 THORNTON AVE
Second Line	:
City	:	NEWARK
State	:	CA
Zip	:	94560-3732
Country	:	US
Telephone Number	:	510-248-1860
Fax Number	:

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

Provider Enumeration Date	:	06/05/2012
Last Update Date	:	01/29/2020

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Directions to “ BERNARDITA MENDEZ ROE NP” Practice Location

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