Provider Demographics
NPI:1306361290
Name:JOSE, BINDU K
Entity Type:Individual
Prefix:
First Name:BINDU
Middle Name:K
Last Name:JOSE
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 1:3003 N CENTRAL AVE FL 20
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2928
Mailing Address - Country:US
Mailing Address - Phone:602-685-6132
Mailing Address - Fax:602-302-7925
Practice Address - Street 1:8836 N 23RD AVE STE B1
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85021-4175
Practice Address - Country:US
Practice Address - Phone:602-685-6000
Practice Address - Fax:602-216-7040
Is Sole Proprietor?:No
Enumeration Date:2017-08-11
Last Update Date:2017-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10406363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health