Healthcare Provider Details

I. General information

NPI: 1093939225
Provider Name (Legal Business Name): ELIZABETH VALENCIA BERNARDINO M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 03/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7055 VETERANS BLVD UNIT C
BURR RIDGE IL
60527-5634
US

IV. Provider business mailing address

7055 VETERANS BLVD UNIT C
BURR RIDGE IL
60527-5634
US

V. Phone/Fax

Practice location:
  • Phone: 630-325-4899
  • Fax: 630-325-4811
Mailing address:
  • Phone: 630-325-4899
  • Fax: 630-325-4811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0015X
TaxonomyPsychosomatic Medicine Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: