Provider Demographics
NPI:1821249376
Name:BERNARDO, BELINDA LA MADRID (NP)
Entity Type:Individual
Prefix:
First Name:BELINDA
Middle Name:LA MADRID
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:BELINDA
Other - Middle Name:ROSE
Other - Last Name:LA MADRID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:15243 VANOWEN ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3605
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-782-4864
Practice Address - Street 1:14901 RINALDI ST
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1204
Practice Address - Country:US
Practice Address - Phone:818-365-1339
Practice Address - Fax:818-898-4201
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17604363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABS000ZMedicare PIN