Provider Demographics
NPI:1477206993
Name:BERNALDEZ, MARC BENEDICT E (MLS(ASCP)CM)
Entity Type:Individual
Prefix:
First Name:MARC BENEDICT
Middle Name:E
Last Name:BERNALDEZ
Suffix:
Gender:M
Credentials:MLS(ASCP)CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18054 EPIC LN
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3270
Mailing Address - Country:US
Mailing Address - Phone:818-687-6653
Mailing Address - Fax:
Practice Address - Street 1:18054 EPIC LN
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3270
Practice Address - Country:US
Practice Address - Phone:818-687-6653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMTA00043890247ZC0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247ZC0005XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyClinical Laboratory Director, Non-physician