Provider Demographics
NPI:1568563849
Name:BERNAL, JENNY A (FMD)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:A
Last Name:BERNAL
Suffix:
Gender:F
Credentials:FMD
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:B
Other - Last Name:IBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3414 W 84TH ST # D110
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33018-4932
Mailing Address - Country:US
Mailing Address - Phone:786-303-5079
Mailing Address - Fax:
Practice Address - Street 1:3414 W 84TH ST # D110
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33018-4932
Practice Address - Country:US
Practice Address - Phone:786-303-5079
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator