Healthcare Provider Details

I. General information

NPI: 1891956082
Provider Name (Legal Business Name): ARTHUR SITO BERNARDEZ JR. S.W.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 06/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1833 BOULEVARD STE 500
JACKSONVILLE FL
32206-4377
US

IV. Provider business mailing address

1833 BOULEVARD STE 500
JACKSONVILLE FL
32206-4377
US

V. Phone/Fax

Practice location:
  • Phone: 904-253-1040
  • Fax: 904-798-4803
Mailing address:
  • Phone: 904-253-1040
  • Fax: 904-798-4803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: