Provider Demographics
NPI:1811722770
Name:BERNARDO, GWENDOLYN REBECCA (MASSAGE THERAPIST)
Entity type:Individual
Prefix:
First Name:GWENDOLYN
Middle Name:REBECCA
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:MASSAGE THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15505 LEMAY ST
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91406
Mailing Address - Country:US
Mailing Address - Phone:415-505-7337
Mailing Address - Fax:
Practice Address - Street 1:15505 LEMAY ST
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91406
Practice Address - Country:US
Practice Address - Phone:415-505-7337
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-02
Last Update Date:2024-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist