Healthcare Provider Details

I. General information

NPI: 1801812110
Provider Name (Legal Business Name): ERNESTO BERNAL-MIZRACHI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 NW 10TH AVE
MIAMI FL
33136-1011
US

IV. Provider business mailing address

1450 NW 10TH AVE
MIAMI FL
33136-1011
US

V. Phone/Fax

Practice location:
  • Phone: 305-243-3636
  • Fax:
Mailing address:
  • Phone: 305-243-3636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number111143
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number4301095157
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME127366
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: