Healthcare Provider Details

I. General information

NPI: 1538071907
Provider Name (Legal Business Name): AXICALLI BERNAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

370 E MARKET ST
AKRON OH
44304-1526
US

IV. Provider business mailing address

370 E MARKET ST
AKRON OH
44304-1526
US

V. Phone/Fax

Practice location:
  • Phone: 234-312-3607
  • Fax:
Mailing address:
  • Phone: 234-312-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code405300000X
TaxonomyPrevention Professional
License NumberRA.169484
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: