Provider Demographics
NPI:1609084631
Name:BERNARDO, CRIS MARIA (RPT)
Entity Type:Individual
Prefix:MS
First Name:CRIS
Middle Name:MARIA
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1359 S BERKLEY ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4608
Mailing Address - Country:US
Mailing Address - Phone:714-821-0623
Mailing Address - Fax:
Practice Address - Street 1:1401 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-1711
Practice Address - Country:US
Practice Address - Phone:714-239-6264
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 29391225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist