Provider Demographics
NPI:1255344768
Name:DERAMO, BERNADINE M (NP)
Entity type:Individual
Prefix:
First Name:BERNADINE
Middle Name:M
Last Name:DERAMO
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:500 S ANAHEIM HILLS RD
Mailing Address - Street 2:STE #206
Mailing Address - City:ANAHEIM HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92807
Mailing Address - Country:US
Mailing Address - Phone:714-282-6934
Mailing Address - Fax:714-282-6935
Practice Address - Street 1:500 S ANAHEIM HILLS RD
Practice Address - Street 2:STE #206
Practice Address - City:ANAHEIM HILLS
Practice Address - State:CA
Practice Address - Zip Code:92807
Practice Address - Country:US
Practice Address - Phone:714-282-6934
Practice Address - Fax:714-282-6935
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2021-10-21
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Provider Licenses
StateLicense IDTaxonomies
CANP11546207R00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224770Medicare PIN