Individual
HEMALATA N BANSODE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
10450 MEADOW LARK AVE, MORENO VALLEY, CA 92557-2750
(951) 323-0536
Mailing address
10450 MEADOW LARK AVE, MORENO VALLEY, CA 92557-2750
(951) 323-0536
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
704282
CA
Other
Enumeration date
06/23/2019
Last updated
06/23/2019
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