Provider Demographics
NPI:1003891318
Name:BERNAL, MARIO SR (MD)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:
Last Name:BERNAL
Suffix:SR
Gender:M
Credentials:MD
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Mailing Address - Street 1:9546 CALLE DIAZ WAY
Mailing Address - Street 2:CONDOMINIO ASTRALIS APT 910
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-1401
Mailing Address - Country:US
Mailing Address - Phone:787-575-2473
Mailing Address - Fax:787-764-6870
Practice Address - Street 1:AVE PONCE DE LEON 716
Practice Address - Street 2:OFICINA 205
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00918
Practice Address - Country:US
Practice Address - Phone:787-764-6870
Practice Address - Fax:787-764-6870
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-08
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR53282084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D83328Medicare UPIN
0026897Medicare ID - Type Unspecified