Healthcare Provider Details

I. General information

NPI: 1790696490
Provider Name (Legal Business Name): RAFAEL ULISES BERNAL-GONZALEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3702 RUFFIN RD STE 100
SAN DIEGO CA
92123-1893
US

IV. Provider business mailing address

3702 RUFFIN RD STE 100
SAN DIEGO CA
92123-1893
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-4300
  • Fax: 619-297-4400
Mailing address:
  • Phone: 619-297-4300
  • Fax: 619-297-4400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2849969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: