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General NPI Number Information
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NPI Number | 1245585058
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Entity Type | Organization
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Legal Business Name | CONRAD BUGARIN BERNISTO
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Dates
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Enumeration Date | 07/18/2012
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Last Update Date | 07/18/2012
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Provider Practice Location Address
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Address Line | 94-141 MAKOA ST
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City | WAIPAHU
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State | HI
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Zip | 96797-4728
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Country | US
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Telephone | 808-282-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 4348 WAIALAE AVE # 656
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City | HONOLULU
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State | HI
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Zip | 96816-5767
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Country | US
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Telephone | 808-282-1907
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CONRAD BERNISTO
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Credential | PSYD
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Telephone | 808-282-1907
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY-1291
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License Number State | HI
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