Provider Demographics
NPI:1073746467
Name:BERNAL, EVELIN L
Entity Type:Individual
Prefix:
First Name:EVELIN
Middle Name:L
Last Name:BERNAL
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 1:12053 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-2337
Mailing Address - Country:US
Mailing Address - Phone:562-923-9202
Mailing Address - Fax:562-923-9457
Practice Address - Street 1:12053 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2337
Practice Address - Country:US
Practice Address - Phone:562-923-9202
Practice Address - Fax:562-923-9457
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-01
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6336230001Medicare NSC