Provider Demographics
NPI:1801628078
Name:DELARIVA, BERNADETTE MARTINA
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:MARTINA
Last Name:DELARIVA
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:BERNADETTE
Other - Middle Name:MARTINA
Other - Last Name:DELARIVA FLORES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1174 SALLY ST
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-4831
Mailing Address - Country:US
Mailing Address - Phone:408-665-1421
Mailing Address - Fax:
Practice Address - Street 1:290 IOOF AVE
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-5204
Practice Address - Country:US
Practice Address - Phone:408-846-2100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-16
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator