Healthcare Provider Details

I. General information

NPI: 1114852241
Provider Name (Legal Business Name): MELANIE SUSANA GARCIA-BERNAL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 ASHBY AVE
BERKELEY CA
94705-2067
US

IV. Provider business mailing address

133 ORIOLE CT
HERCULES CA
94547-1610
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-6546
  • Fax:
Mailing address:
  • Phone: 510-316-4631
  • Fax: 510-316-4631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number836663
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number836663
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: