Individual
BIANCA NEEMA WIBISONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1071 BLOSSOM HILL RD, SAN JOSE, CA 95123-1105
(408) 445-4020
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
62531
CA
Other
Enumeration date
05/31/2023
Last updated
09/13/2023
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