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General NPI Number Information
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NPI Number | 1861881997
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Entity Type | Organization
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Legal Business Name | ROMULO BERNAL
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Dates
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Enumeration Date | 01/13/2015
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Last Update Date | 01/13/2015
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Provider Practice Location Address
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Address Line | 3925 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7130
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Country | US
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Telephone | 239-549-1633
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Fax | 239-549-0296
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Provider Business Mailing Address
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Address Line | 3925 DEL PRADO BLVD S
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City | CAPE CORAL
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State | FL
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Zip | 33904-7130
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Country | US
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Telephone | 239-549-1633
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Fax | 239-549-0296
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Authorized Official
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Title or Position | OWNER / PHYSICIAN
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Name | ROMULO A BERNAL
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Credential | MD
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Telephone | 239-549-1633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME33340
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License Number State | FL
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