Healthcare Provider Details

I. General information

NPI: 1366766800
Provider Name (Legal Business Name): CYNTHIA P BERNAL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1135 E STATE ROAD 434
WINTER SPRINGS FL
32708-2746
US

IV. Provider business mailing address

1135 E STATE ROAD 434 STE 1001
WINTER SPRINGS FL
32708-2744
US

V. Phone/Fax

Practice location:
  • Phone: 407-635-3220
  • Fax: 407-636-7841
Mailing address:
  • Phone: 407-635-3220
  • Fax: 407-636-7841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME138357
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: