Provider Demographics
NPI:1154970697
Name:ABADILLA, BERNADETTE MARIE CORPUZ (RN)
Entity type:Individual
Prefix:MS
First Name:BERNADETTE MARIE
Middle Name:CORPUZ
Last Name:ABADILLA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 GAVILAN WAY
Mailing Address - Street 2:
Mailing Address - City:MILLBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94030-2843
Mailing Address - Country:US
Mailing Address - Phone:650-892-1302
Mailing Address - Fax:
Practice Address - Street 1:1437 GAVILAN WAY
Practice Address - Street 2:
Practice Address - City:MILLBRAE
Practice Address - State:CA
Practice Address - Zip Code:94030-2843
Practice Address - Country:US
Practice Address - Phone:650-892-1302
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-07
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95174769163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse