MEDICARE: JENNIFER BERNAL CFA. LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZC0007X	Surgical Assistant

General Provider Information

NPI Number	:	1396054888
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JENNIFER BERNAL CFA. LLC

Provider Business Mailing Address
First Line	:	PO BOX 1843
Second Line	:
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142
Country	:	US
Telephone Number	:	480-209-8526
Fax Number	:

Provider Business Practice Location Address
First Line	:	3664 E. SHAPINSAY DRIVE
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140
Country	:	US
Telephone Number	:	480-209-8526
Fax Number	:

Authorized Official
Title or Position	:	CERTIFIED FIRST ASSISANT
Name	:	JENNIFER BERNAL
Credential	:	CFA
Telephone Number	:	480-209-8526

Provider Enumeration Date	:	09/30/2010
Last Update Date	:	09/30/2010

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