Provider Demographics
NPI:1508113887
Name:BANDES, MARIO SALOMON JR
Entity Type:Individual
Prefix:MR
First Name:MARIO
Middle Name:SALOMON
Last Name:BANDES
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2015 PIONEER CT STE B
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-1736
Mailing Address - Country:US
Mailing Address - Phone:650-348-6603
Mailing Address - Fax:650-638-1602
Practice Address - Street 1:2015 PIONEER CT STE B
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-1736
Practice Address - Country:US
Practice Address - Phone:650-348-6603
Practice Address - Fax:650-638-1602
Is Sole Proprietor?:No
Enumeration Date:2012-08-06
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF90772106H00000X
101YM0800X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health