Provider Demographics
NPI:1316388986
Name:BERNARDEZ, RINA
Entity Type:Individual
Prefix:
First Name:RINA
Middle Name:
Last Name:BERNARDEZ
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 1:300 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2935
Mailing Address - Country:US
Mailing Address - Phone:617-284-7000
Mailing Address - Fax:617-591-4362
Practice Address - Street 1:300 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2935
Practice Address - Country:US
Practice Address - Phone:617-284-7000
Practice Address - Fax:617-591-4362
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-11
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA261QP2300XOtherCAMBRIDGE HEALTH ALLIANCE