Provider Demographics
NPI:1487025334
Name:BERNAL, BELINDA
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:
Other - Last Name:BERNAL-MONTANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1815 ENCLAVE PKWY
Mailing Address - Street 2:#6307
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-3671
Mailing Address - Country:US
Mailing Address - Phone:832-863-6564
Mailing Address - Fax:
Practice Address - Street 1:1815 ENCLAVE PKWY
Practice Address - Street 2:#6307
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-3671
Practice Address - Country:US
Practice Address - Phone:832-863-6564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2014668172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker