Provider Demographics
NPI:1841694189
Name:EDWIN, BINDU LALITHA BHAI SOMAN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BINDU
Middle Name:LALITHA BHAI SOMAN
Last Name:EDWIN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:BINDU
Other - Middle Name:LALITHA BHAI
Other - Last Name:SOMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NURSE PRACTITIONER
Mailing Address - Street 1:2084 CALLE MESA ALTA
Mailing Address - Street 2:
Mailing Address - City:MILPITAS
Mailing Address - State:CA
Mailing Address - Zip Code:95035-7852
Mailing Address - Country:US
Mailing Address - Phone:248-943-7121
Mailing Address - Fax:
Practice Address - Street 1:2577 SAMARITAN DR
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-4100
Practice Address - Country:US
Practice Address - Phone:408-871-3400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-15
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704254186363LF0000X
CA95017140363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care