Provider Demographics
NPI:1891813200
Name:BERNARD, RICK JAMES (LAC)
Entity Type:Individual
Prefix:MR
First Name:RICK
Middle Name:JAMES
Last Name:BERNARD
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1314 LINCOLN AVE
Mailing Address - Street 2:STE 2F
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95125-3012
Mailing Address - Country:US
Mailing Address - Phone:408-291-0179
Mailing Address - Fax:408-297-7033
Practice Address - Street 1:1314 LINCOLN AVE
Practice Address - Street 2:STE 2F
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3012
Practice Address - Country:US
Practice Address - Phone:408-291-0179
Practice Address - Fax:408-297-7033
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA4242171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist