Provider Demographics
NPI:1215508551
Name:BENDICION, JAKE (PA-C)
Entity type:Individual
Prefix:MR
First Name:JAKE
Middle Name:
Last Name:BENDICION
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1851 STEAMBOAT PKWY UNIT 2704
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-6344
Mailing Address - Country:US
Mailing Address - Phone:702-683-3888
Mailing Address - Fax:
Practice Address - Street 1:9159 W FLAMINGO RD STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89147-6454
Practice Address - Country:US
Practice Address - Phone:702-683-3888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-07
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA0595363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical