Provider Demographics
NPI:1013578822
Name:BANSODE, HEMALATA N
Entity Type:Individual
Prefix:
First Name:HEMALATA
Middle Name:N
Last Name:BANSODE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 MEADOW LARK AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92557-2750
Mailing Address - Country:US
Mailing Address - Phone:951-323-0536
Mailing Address - Fax:
Practice Address - Street 1:10450 MEADOW LARK AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-2750
Practice Address - Country:US
Practice Address - Phone:951-323-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-23
Last Update Date:2019-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA704282163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse