Provider Demographics
NPI:1609395813
Name:BERNAL, MARCELA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARCELA
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2251 W PRESERVE WAY APT 204
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-6595
Mailing Address - Country:US
Mailing Address - Phone:305-331-5583
Mailing Address - Fax:
Practice Address - Street 1:2251 W PRESERVE WAY APT 204
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-6595
Practice Address - Country:US
Practice Address - Phone:305-331-5583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9110570363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant