Healthcare Provider Details

I. General information

NPI: 1891783288
Provider Name (Legal Business Name): CHRISTINE BERNET PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 07/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2031 2ND AVE
SAN DIEGO CA
92101-2015
US

IV. Provider business mailing address

2031 2ND AVE
SAN DIEGO CA
92101-2015
US

V. Phone/Fax

Practice location:
  • Phone: 619-699-8443
  • Fax: 619-237-9499
Mailing address:
  • Phone: 619-699-8443
  • Fax: 619-237-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY15679
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY15679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: