Provider Demographics
NPI:1790405512
Name:RICE, BERNARD (PMHNP)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:RICE
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:187 E 18TH ST APT 207
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3056
Mailing Address - Country:US
Mailing Address - Phone:734-660-0221
Mailing Address - Fax:
Practice Address - Street 1:760 N RODEO CIR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92869-2301
Practice Address - Country:US
Practice Address - Phone:734-660-0221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95022893363LP0808X
CA95231504163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse