Provider Demographics
NPI:1508686437
Name:BERNAL-MUNOZ, DIANA VANESSA
Entity type:Individual
Prefix:
First Name:DIANA
Middle Name:VANESSA
Last Name:BERNAL-MUNOZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIANA
Other - Middle Name:VANESSA
Other - Last Name:BERNAL-MUNOZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:14639 14TH AVE APT B3
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-2401
Mailing Address - Country:US
Mailing Address - Phone:929-316-1600
Mailing Address - Fax:
Practice Address - Street 1:2101 41ST AVE
Practice Address - Street 2:
Practice Address - City:LONG ISLAND CITY
Practice Address - State:NY
Practice Address - Zip Code:11101-4801
Practice Address - Country:US
Practice Address - Phone:718-784-2240
Practice Address - Fax:914-471-8022
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007074124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist