Healthcare Provider Details

I. General information

NPI: 1649646738
Provider Name (Legal Business Name): BRENDA BERNAL FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2015
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date: 01/06/2026
Reactivation Date: 07/21/2026

III. Provider practice location address

1600 SAN FERNANDO RD # A
SAN FERNANDO CA
91340-3115
US

IV. Provider business mailing address

1600 SAN FERNANDO RD # A
SAN FERNANDO CA
91340-3115
US

V. Phone/Fax

Practice location:
  • Phone: 818-898-1388
  • Fax: 818-270-9590
Mailing address:
  • Phone: 818-898-1388
  • Fax: 818-270-9590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95066255
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95008093
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: