Provider Demographics
NPI:1467147124
Name:BERNARDO, MYRNA CRISTINA TANEDO (RDHAP)
Entity Type:Individual
Prefix:MISS
First Name:MYRNA CRISTINA
Middle Name:TANEDO
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:CRISTINA
Other - Middle Name:TANEDO
Other - Last Name:BERNARDO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12798 WITHERSPOON RD
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-3136
Mailing Address - Country:US
Mailing Address - Phone:909-662-1968
Mailing Address - Fax:
Practice Address - Street 1:12798 WITHERSPOON RD
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-3136
Practice Address - Country:US
Practice Address - Phone:909-662-1968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-10
Last Update Date:2023-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHAP967124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist