1902444714 NPI number — JOHN BRIDENBECK CNIM, R. EEG. T

Table of content: ARTURO PALACIOS (NPI 1316089089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902444714 NPI number — JOHN BRIDENBECK CNIM, R. EEG. T

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRIDENBECK
Provider First Name:
JOHN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CNIM, R. EEG. T
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1902444714
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8135 SARATOGA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL DORADO HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95762-4590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
971-226-6108
Provider Business Practice Location Address Fax Number:
510-826-5898
Provider Enumeration Date:
12/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 156F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 246ZE0600X , with the licence number: 4184 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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