Provider Demographics
NPI:1487197141
Name:DEBERNARDI, RAFAELLA (PA)
Entity Type:Individual
Prefix:
First Name:RAFAELLA
Middle Name:
Last Name:DEBERNARDI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1188 PADRE DR STE 113
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2261
Mailing Address - Country:US
Mailing Address - Phone:831-244-0497
Mailing Address - Fax:775-490-0211
Practice Address - Street 1:1188 PADRE DR STE 113
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2261
Practice Address - Country:US
Practice Address - Phone:831-244-0497
Practice Address - Fax:775-490-0211
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-29
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ6562363AM0700X
FLPA9109931363AM0700X
CA58118363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ264423Medicaid