Provider Demographics
NPI:1902444714
Name:BRIDENBECK, JOHN (CNIM, R EEG T)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:BRIDENBECK
Suffix:
Gender:M
Credentials:CNIM, R EEG T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2930 DOMINGO AVE STE 529
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2454
Mailing Address - Country:US
Mailing Address - Phone:971-226-6108
Mailing Address - Fax:
Practice Address - Street 1:8135 SARATOGA WAY
Practice Address - Street 2:
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4590
Practice Address - Country:US
Practice Address - Phone:971-226-6108
Practice Address - Fax:510-826-5898
Is Sole Proprietor?:No
Enumeration Date:2019-12-12
Last Update Date:2022-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
156F00000X
4184246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic
No156F00000XEye and Vision Services ProvidersTechnician/Technologist