Provider Demographics
NPI:1457851545
Name:BERNAL, ELIZABETH SERNA
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:SERNA
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 1:2813 S MAIN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-5942
Mailing Address - Country:US
Mailing Address - Phone:951-750-9526
Mailing Address - Fax:951-737-2783
Practice Address - Street 1:2813 S MAIN ST FL 2
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-5942
Practice Address - Country:US
Practice Address - Phone:951-750-9526
Practice Address - Fax:951-737-2783
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHUITZLPGXKQSFVOD175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist