Provider Demographics
NPI:1104362862
Name:TERRES, BERNARDO M
Entity Type:Individual
Prefix:
First Name:BERNARDO
Middle Name:M
Last Name:TERRES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2218 MERMAID DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3621
Mailing Address - Country:US
Mailing Address - Phone:915-249-6079
Mailing Address - Fax:
Practice Address - Street 1:2218 MERMAID DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-3621
Practice Address - Country:US
Practice Address - Phone:915-249-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-18
Last Update Date:2018-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX147128310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility