Provider Demographics
NPI:1558443572
Name:BERNAL, MIKI (MA, OT/L, CHT)
Entity type:Individual
Prefix:MS
First Name:MIKI
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:MA, OT/L, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 CORTE ESTANTE
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:93673-6803
Mailing Address - Country:US
Mailing Address - Phone:949-338-9131
Mailing Address - Fax:949-498-9131
Practice Address - Street 1:1 CORTE ESTANTE
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673
Practice Address - Country:US
Practice Address - Phone:949-338-9131
Practice Address - Fax:949-498-9131
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-19
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAO.T. 6267225XH1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XH1200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistHand
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAN213942Medicare ID - Type Unspecified