Provider Demographics
NPI:1366787772
Name:HEERBOTH, AMANDA NICOLE DELGADO (NP)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:NICOLE DELGADO
Last Name:HEERBOTH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NICOLE
Other - Last Name:DELGADO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1452 ALEGRIA LOOP
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4559
Mailing Address - Country:US
Mailing Address - Phone:408-666-4146
Mailing Address - Fax:
Practice Address - Street 1:5671 SANTA TERESA BLVD
Practice Address - Street 2:105
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-6512
Practice Address - Country:US
Practice Address - Phone:408-284-2280
Practice Address - Fax:408-754-0450
Is Sole Proprietor?:No
Enumeration Date:2012-12-11
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA779153163WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics