Healthcare Provider Details

I. General information

NPI: 1467414540
Provider Name (Legal Business Name): BERNABE MARINDUQUE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7965 SIERRA AVE SUITE E
FONTANA CA
92336-3329
US

IV. Provider business mailing address

1660 KENDALL DR SUITE B
SAN BERNARDINO CA
92407-2832
US

V. Phone/Fax

Practice location:
  • Phone: 909-356-4459
  • Fax: 909-355-4261
Mailing address:
  • Phone: 909-881-7320
  • Fax: 909-881-7329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberC50713
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: