Provider Demographics
NPI:1518714849
Name:AMOFA, BERNADETTE ASANTE
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:ASANTE
Last Name:AMOFA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 S FREMONT AVE
Mailing Address - Street 2:UNIT 7, BLD A10, N10100
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803
Mailing Address - Country:US
Mailing Address - Phone:626-457-4240
Mailing Address - Fax:626-457-4245
Practice Address - Street 1:1000 S FREMONT AVE
Practice Address - Street 2:UNIT 7, BLD A10, N10100
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803
Practice Address - Country:US
Practice Address - Phone:626-457-4240
Practice Address - Fax:626-457-4245
Is Sole Proprietor?:No
Enumeration Date:2024-05-03
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant