Provider Demographics
NPI:1457528713
Name:BERNAL, ROSALIE V (MT)
Entity type:Individual
Prefix:
First Name:ROSALIE
Middle Name:V
Last Name:BERNAL
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2037 JERRY MURPHY RD
Mailing Address - Street 2:STE. 200
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1250
Mailing Address - Country:US
Mailing Address - Phone:719-251-7222
Mailing Address - Fax:
Practice Address - Street 1:2037 JERRY MURPHY RD
Practice Address - Street 2:STE. 200
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81001-1250
Practice Address - Country:US
Practice Address - Phone:719-251-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist