Provider Demographics
NPI:1588233472
Name:BERNARDO, RICHARD MARAVE (RN)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:MARAVE
Last Name:BERNARDO
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6630 INDEPENDENCE AVE APT 301
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2904
Mailing Address - Country:US
Mailing Address - Phone:818-818-1903
Mailing Address - Fax:
Practice Address - Street 1:6630 INDEPENDENCE AVE APT 301
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2904
Practice Address - Country:US
Practice Address - Phone:818-818-1903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-23
Last Update Date:2021-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95250524163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse