Provider Demographics
NPI:1366682767
Name:ANSOLABEHERE, BERNADETTE TERESA (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:TERESA
Last Name:ANSOLABEHERE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:455 OCONNOR DR STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1644
Mailing Address - Country:US
Mailing Address - Phone:408-283-7767
Mailing Address - Fax:408-283-7608
Practice Address - Street 1:455 OCONNOR DR STE 200
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1632
Practice Address - Country:US
Practice Address - Phone:408-283-7676
Practice Address - Fax:408-283-7646
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-12-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA103954207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine