Provider Demographics
NPI:1740433069
Name:BERNARDO, KRISTINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTINE
Middle Name:A
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3618 MENDOCINO PARK
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2444
Mailing Address - Country:US
Mailing Address - Phone:602-454-2144
Mailing Address - Fax:602-431-2149
Practice Address - Street 1:16620 SAN PEDRO AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2679
Practice Address - Country:US
Practice Address - Phone:210-871-4701
Practice Address - Fax:210-688-4596
Is Sole Proprietor?:No
Enumeration Date:2008-10-30
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ40353207R00000X, 208M00000X
TXS3633207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXS3633OtherTEXAS MEDICAL BOARD
AZ40353OtherAZ LICENSE