Healthcare Provider Details

I. General information

NPI: 1831727007
Provider Name (Legal Business Name): EFREN BERNAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1856 E INNOVATION PARK DR
ORO VALLEY AZ
85755-1963
US

IV. Provider business mailing address

PO BOX 188
MARANA AZ
85653-0188
US

V. Phone/Fax

Practice location:
  • Phone: 520-825-7111
  • Fax: 520-818-1253
Mailing address:
  • Phone: 520-682-4111
  • Fax: 520-818-1253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30891
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number69629
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: