Healthcare Provider Details

I. General information

NPI: 1740965169
Provider Name (Legal Business Name): RAFAEL BERNARDINO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 NOTTINGHAM DR
OXNARD CA
93030-8772
US

IV. Provider business mailing address

315 CAMINO DEL REMEDIO
SANTA BARBARA CA
93110-1332
US

V. Phone/Fax

Practice location:
  • Phone: 805-844-9933
  • Fax:
Mailing address:
  • Phone: 805-681-5244
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: