Healthcare Provider Details

I. General information

NPI: 1164438511
Provider Name (Legal Business Name): ELIZABETH BERNARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

DURABO CLUSTER AB 101
CAGUAS PR
00925
US

IV. Provider business mailing address

HC 1 BOX 20205
COMERIO PR
00782-9718
US

V. Phone/Fax

Practice location:
  • Phone: 787-316-5590
  • Fax:
Mailing address:
  • Phone: 787-875-0662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number806
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: