Provider Demographics
NPI:1386878700
Name:BITENCOURT, NICOLE GALGOUL (MD)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GALGOUL
Last Name:BITENCOURT
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11175 CAMPUS STREET
Mailing Address - Street 2:COLEMAN PAVILION
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354
Mailing Address - Country:US
Mailing Address - Phone:909-558-4773
Mailing Address - Fax:909-558-0479
Practice Address - Street 1:11175 CAMPUS STREET
Practice Address - Street 2:COLEMAN PAVILION PEDIATRIC RHEUMATOLOGY
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354
Practice Address - Country:US
Practice Address - Phone:909-558-4773
Practice Address - Fax:909-558-0479
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2023-12-18
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Provider Licenses
StateLicense IDTaxonomies
CAA168383207RR0500X, 2080P0216X
TXP91642080P0216X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
No2080P0216XAllopathic & Osteopathic PhysiciansPediatricsPediatric Rheumatology