Provider Demographics
NPI:1508412297
Name:BERNARD, SEAN (CRNA (12/2019))
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:BERNARD
Suffix:
Gender:M
Credentials:CRNA (12/2019)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1557 RUBY DR
Mailing Address - Street 2:
Mailing Address - City:PERRIS
Mailing Address - State:CA
Mailing Address - Zip Code:92571-2919
Mailing Address - Country:US
Mailing Address - Phone:951-756-8348
Mailing Address - Fax:
Practice Address - Street 1:101 THE CITY DR S
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3201
Practice Address - Country:US
Practice Address - Phone:714-456-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95001239367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered