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General NPI Number Information
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NPI Number | 1396078077
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Entity Type | Individual
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Provider Name | OSIRIS R BERNAL
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Gender | Male
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Dates
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Enumeration Date | 09/11/2009
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Last Update Date | 09/11/2009
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Provider Practice Location Address
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Address Line | 9702 RIO HONDO PKWY
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City | EL MONTE
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State | CA
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Zip | 91733-1242
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Country | US
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Telephone | 626-444-1229
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Fax |
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Provider Business Mailing Address
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Address Line | 4343 WILLIAMSBOURGH DR
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City | SACRAMENTO
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State | CA
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Zip | 95823-2006
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Country | US
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Telephone | 916-395-3553
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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