Provider Demographics
NPI:1770233819
Name:CHIU, BERNADETTE LLENADO (MD)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:LLENADO
Last Name:CHIU
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MERCY AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8367
Mailing Address - Country:US
Mailing Address - Phone:209-564-3513
Mailing Address - Fax:209-564-3598
Practice Address - Street 1:1675 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:ATWATER
Practice Address - State:CA
Practice Address - Zip Code:95301-4456
Practice Address - Country:US
Practice Address - Phone:209-383-5500
Practice Address - Fax:209-383-6910
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-23
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA198011207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program