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General NPI Number Information
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NPI Number | 1891934501
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Entity Type | Individual
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Provider Name | JENNIFER BERNABE LIC OPTICIAN
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Gender | Female
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Dates
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Enumeration Date | 02/19/2009
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Last Update Date | 07/06/2021
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Provider Practice Location Address
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Address Line | CALLE JOSE DE DIEGO # 39A
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City | CIALES
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State | PR
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Zip | 00638
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Country | US
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Telephone | 787-526-0833
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Fax |
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Provider Business Mailing Address
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Address Line | URB. GUARICO C/B CASA G#8 VEGA BAJA
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City | VEGA BAJA
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State | PR
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Zip | 00693
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Country | US
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Telephone | 787-627-5818
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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 | 156FX1800X
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Taxonomy Name | Optician
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License Number | 000635
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License Number State | PR
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Taxonomy #2
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 4309
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License Number State | PR
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