Provider Demographics
NPI:1205071859
Name:BENTLEY, MICHAEL NORMAN (RDMS)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:NORMAN
Last Name:BENTLEY
Suffix:
Gender:M
Credentials:RDMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 FRANCISCAN CT
Mailing Address - Street 2:#5
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7073
Mailing Address - Country:US
Mailing Address - Phone:510-683-8559
Mailing Address - Fax:
Practice Address - Street 1:320 FRANCISCAN CT
Practice Address - Street 2:#5
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7073
Practice Address - Country:US
Practice Address - Phone:510-683-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-11
Last Update Date:2008-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1289202471S1302X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471S1302XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistSonography