Provider Demographics
NPI:1891956082
Name:BERNARDEZ, ARTHUR SITO JR (SW)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:SITO
Last Name:BERNARDEZ
Suffix:JR
Gender:M
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1833 BOULEVARD STE 500
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32206-4377
Mailing Address - Country:US
Mailing Address - Phone:904-253-1040
Mailing Address - Fax:904-798-4803
Practice Address - Street 1:1833 BOULEVARD STE 500
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-4377
Practice Address - Country:US
Practice Address - Phone:904-253-1040
Practice Address - Fax:904-798-4803
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-19
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL688436900Medicaid