Provider Demographics
NPI:1982037271
Name:BERNARDINO, CONALU LIWAG (MD)
Entity Type:Individual
Prefix:DR
First Name:CONALU
Middle Name:LIWAG
Last Name:BERNARDINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CONALU
Other - Middle Name:YABUT
Other - Last Name:LIWAG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4601 DALE ROAD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95356-8713
Mailing Address - Country:US
Mailing Address - Phone:209-557-1786
Mailing Address - Fax:209-557-1682
Practice Address - Street 1:4125 BANGS AVE
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95356-8713
Practice Address - Country:US
Practice Address - Phone:209-557-1650
Practice Address - Fax:209-557-1786
Is Sole Proprietor?:No
Enumeration Date:2013-08-09
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA140284208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program