Healthcare Provider Details

I. General information

NPI: 1427581982
Provider Name (Legal Business Name): BELEN QUEREDA BERNABEU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2017
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 S 11TH ST ROOM 204 PAVILLION
PHILADELPHIA PA
19107-4949
US

IV. Provider business mailing address

2200 BENJAMIN FRANKLIN PKWY APT N301
PHILADELPHIA PA
19130-3714
US

V. Phone/Fax

Practice location:
  • Phone: 215-503-3876
  • Fax:
Mailing address:
  • Phone: 267-370-4739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberMT213078
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: