Provider Demographics
NPI:1184842700
Name:BERNALL, FERNANDO LEON (AP)
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:LEON
Last Name:BERNALL
Suffix:
Gender:M
Credentials:AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:88 RIBERIA ST
Mailing Address - Street 2:SUITE 250
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32084-3300
Mailing Address - Country:US
Mailing Address - Phone:904-806-7123
Mailing Address - Fax:
Practice Address - Street 1:88 RIBERIA ST
Practice Address - Street 2:SUITE 250
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32084-3300
Practice Address - Country:US
Practice Address - Phone:904-806-7123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2017-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 643171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist