Provider Demographics
NPI:1942470562
Name:BERNAL, FERNANDO JR
Entity Type:Individual
Prefix:MR
First Name:FERNANDO
Middle Name:
Last Name:BERNAL
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27524 NORTH SPENCER CT.
Mailing Address - Street 2:22-202
Mailing Address - City:CANYON COUNTRY
Mailing Address - State:CA
Mailing Address - Zip Code:91387
Mailing Address - Country:US
Mailing Address - Phone:818-744-3704
Mailing Address - Fax:
Practice Address - Street 1:6931 VAN NUYS BLVD.
Practice Address - Street 2:3RD FLOOR
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405
Practice Address - Country:US
Practice Address - Phone:818-901-4830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-11
Last Update Date:2008-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA219733164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse