Provider Demographics
NPI:1679100911
Name:BENDITO MEDICAL CORPORATION
Entity Type:Organization
Organization Name:BENDITO MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHIOMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KALU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-402-4601
Mailing Address - Street 1:1780 E HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-4618
Mailing Address - Country:US
Mailing Address - Phone:818-618-3728
Mailing Address - Fax:818-888-3775
Practice Address - Street 1:1780 E HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-4618
Practice Address - Country:US
Practice Address - Phone:909-402-4601
Practice Address - Fax:909-402-4609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty