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IGOR M BEDEROV NURSE PRACTITIONER
>> Registered Nurse >> Nursing Service ProvidersRegistrant NPI Number: 1659301000
Individual Registrant: IGOR M BEDEROV NURSE PRACTITIONER
Gender: M
Sole Proprietor
Gender: M
Sole Proprietor
Location and contact information for practice:
262 BONITA LN FOSTER CITY, CA 94404-1982 US
Tel: 650-571-9090 Fax: --
Tel: 650-571-9090 Fax: --
Contact information for business:
262 BONITA LN FOSTER CITY, CA 94404-1982 US
Tel: 650-571-9090 Fax: --
Tel: 650-571-9090 Fax: --
Registration Information:
NPI: 1659301000
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 163W00000X | Nursing Service Providers Registered Nurse | CA | RN586047 |
| Y | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers Nurse Practitioner | CA | NP21555 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
