Healthcare Provider Details

I. General information

NPI: 1407765266
Provider Name (Legal Business Name): RENEE CHRISTINE BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12710 3RD ST SPC 95
YUCAIPA CA
92399-4505
US

IV. Provider business mailing address

12710 3RD ST 95
YUCAIPA CA
92399-4505
US

V. Phone/Fax

Practice location:
  • Phone: 909-278-3828
  • Fax:
Mailing address:
  • Phone: 909-278-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95464941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: