=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487197141
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RAFAELLA DEBERNARDI P.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/29/2016
-----------------------------------------------------
Last Update Date | 02/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1188 PADRE DR STE 113
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-244-0497
-----------------------------------------------------
Fax | 775-490-0211
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1188 PADRE DR STE 113
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2261
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-244-0497
-----------------------------------------------------
Fax | 775-490-0211
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 6562
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | PA9109931
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number | 58118
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------