Provider Demographics
NPI:1841787991
Name:BANDOOKWALA, MARIA (FNP)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:BANDOOKWALA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 KASLIN DR
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-7906
Mailing Address - Country:US
Mailing Address - Phone:832-279-1989
Mailing Address - Fax:
Practice Address - Street 1:3320 TULLY RD STE 1
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0800
Practice Address - Country:US
Practice Address - Phone:209-550-5200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-15
Last Update Date:2022-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95016458363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily