Provider Demographics
NPI:1932330610
Name:BERNOU, JACQUES JR (MSTCM)
Entity Type:Individual
Prefix:
First Name:JACQUES
Middle Name:
Last Name:BERNOU
Suffix:JR
Gender:M
Credentials:MSTCM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3744 MT DIABLO BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-3602
Mailing Address - Country:US
Mailing Address - Phone:925-962-9228
Mailing Address - Fax:
Practice Address - Street 1:3744 MT DIABLO BLVD STE 305
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-3602
Practice Address - Country:US
Practice Address - Phone:925-962-9228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC 9788171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist