MEDICARE: MARC BENEDICT E BERNALDEZ MLS(ASCP)CM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	247ZC0005X	Clinical Laboratory Director (Non-physician)	MTA00043890	CA

General Provider Information

NPI Number	:	1477206993
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC BENEDICT E BERNALDEZ MLS(ASCP)CM

Provider Business Mailing Address
First Line	:	18054 EPIC LN
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-3270
Country	:	US
Telephone Number	:	818-687-6653
Fax Number	:

Provider Business Practice Location Address
First Line	:	18054 EPIC LN
Second Line	:
City	:	SANTA CLARITA
State	:	CA
Zip	:	91350-3270
Country	:	US
Telephone Number	:	818-687-6653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/03/2022
Last Update Date	:	02/03/2022

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