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General NPI Number Information
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NPI Number | 1003198862
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Entity Type | Organization
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Legal Business Name | BERNAL PEDIATRIC CLINIC
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Dates
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Enumeration Date | 09/16/2011
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Last Update Date | 09/16/2011
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Provider Practice Location Address
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Address Line | 810 E VETERANS BLVD SUITE H
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City | PALMVIEW
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State | TX
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Zip | 78572-5018
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Country | US
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Telephone | 956-519-4647
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Fax | 956-519-4578
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Provider Business Mailing Address
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Address Line | 810 E VETERANS BLVD SUITE H
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City | PALMVIEW
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State | TX
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Zip | 78572-5018
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Country | US
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Telephone | 956-519-4647
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Fax | 956-519-4578
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. JAIME E BERNAL
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Credential | MD
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Telephone | 956-519-4647
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | K3096
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License Number State | TX
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