=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396054888
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JENNIFER BERNAL CFA. LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/30/2010
-----------------------------------------------------
Last Update Date | 09/30/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3664 E. SHAPINSAY DRIVE
-----------------------------------------------------
City | SAN TAN VALLEY
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-209-8526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1843
-----------------------------------------------------
City | QUEEN CREEK
-----------------------------------------------------
State | AZ
-----------------------------------------------------
Zip | 85142
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 480-209-8526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CERTIFIED FIRST ASSISANT
-----------------------------------------------------
Name | JENNIFER BERNAL
-----------------------------------------------------
Credential | CFA
-----------------------------------------------------
Telephone | 480-209-8526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 246ZC0007X
-----------------------------------------------------
Taxonomy Name | Surgical Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------