Provider Demographics
NPI:1396078077
Name:BERNAL, OSIRIS R
Entity type:Individual
Prefix:
First Name:OSIRIS
Middle Name:R
Last Name:BERNAL
Suffix:
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 1:4343 WILLIAMSBOURGH DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95823-2006
Mailing Address - Country:US
Mailing Address - Phone:916-395-3553
Mailing Address - Fax:
Practice Address - Street 1:9702 RIO HONDO PKWY
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-1242
Practice Address - Country:US
Practice Address - Phone:626-444-1229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2009-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)