Provider Demographics
NPI:1679185383
Name:BERNARDINO-BUENAVENTURA, ZHERINA SIASICO (PT,DPT)
Entity Type:Individual
Prefix:DR
First Name:ZHERINA
Middle Name:SIASICO
Last Name:BERNARDINO-BUENAVENTURA
Suffix:
Gender:F
Credentials:PT,DPT
Other - Prefix:
Other - First Name:ZHERINA
Other - Middle Name:SIASICO
Other - Last Name:BERNARDINO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT,DPT
Mailing Address - Street 1:6107 VERDE PLACE LN
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2827
Mailing Address - Country:US
Mailing Address - Phone:425-879-3822
Mailing Address - Fax:
Practice Address - Street 1:6107 VERDE PLACE LN
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2827
Practice Address - Country:US
Practice Address - Phone:425-879-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12593412081P0010X, 208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine