Provider Demographics
NPI:1912049974
Name:BERNALES, NOEL CUEVAS (MD)
Entity Type:Individual
Prefix:
First Name:NOEL
Middle Name:CUEVAS
Last Name:BERNALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15995 TUSCOLA RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2159
Mailing Address - Country:US
Mailing Address - Phone:760-946-4004
Mailing Address - Fax:760-946-4944
Practice Address - Street 1:15995 TUSCOLA RD
Practice Address - Street 2:SUITE 203
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-2159
Practice Address - Country:US
Practice Address - Phone:760-946-4004
Practice Address - Fax:760-946-4944
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA694922084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00228072OtherRAILROAD MEDICARE
CA00A694920Medicaid
CA00A694920Medicaid
CAH33536Medicare UPIN