Healthcare Provider Details

I. General information

NPI: 1235470360
Provider Name (Legal Business Name): RIA KRISTINE BABALCON BERNARDO NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UCLA RONALD REAGAN MEDICAL CENTER 5 NICU 757 WESTWOOD PLAZA
LOS ANGELES CA
90095-0001
US

IV. Provider business mailing address

5767 W CENTURY BLVD STE 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-267-7565
  • Fax:
Mailing address:
  • Phone: 310-301-8707
  • Fax: 310-301-8751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0000X
TaxonomyNeonatal Nurse Practitioner
License Number19986
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: