Provider Demographics
NPI:1952076762
Name:BEDIAMOL, NOELLE LANI (PTA)
Entity Type:Individual
Prefix:
First Name:NOELLE
Middle Name:LANI
Last Name:BEDIAMOL
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3551 SEAWARD CIR APT 344
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5239
Mailing Address - Country:US
Mailing Address - Phone:714-742-2522
Mailing Address - Fax:
Practice Address - Street 1:3551 SEAWARD CIR APT 344
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-5239
Practice Address - Country:US
Practice Address - Phone:714-742-2522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant