Provider Demographics
NPI:1578906467
Name:BANDELE, JOYCE I
Entity Type:Individual
Prefix:MRS
First Name:JOYCE
Middle Name:I
Last Name:BANDELE
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 1:34664 COUNTY LINE RD SUITE 14
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399
Mailing Address - Country:US
Mailing Address - Phone:909-795-6615
Mailing Address - Fax:909-795-6607
Practice Address - Street 1:34664 COUNTY LINE RD SUITE 14
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399
Practice Address - Country:US
Practice Address - Phone:909-795-6615
Practice Address - Fax:909-795-6607
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies