Provider Demographics
NPI:1407457542
Name:BEDOLLA, MARIA ISABEL (PCA)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ISABEL
Last Name:BEDOLLA
Suffix:
Gender:F
Credentials:PCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5402 S SIR RICHARD DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4863
Mailing Address - Country:US
Mailing Address - Phone:702-305-5447
Mailing Address - Fax:
Practice Address - Street 1:5402 S SIR RICHARD DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-4863
Practice Address - Country:US
Practice Address - Phone:702-305-5447
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-05
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health