MEDICARE: DR. JANET LEE BERNABO PH.D.

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	103TC0700X	Clinical Psychologist	PSY7951	CA

General Provider Information

NPI Number	:	1942220801
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANET LEE BERNABO PH.D.

Provider Business Mailing Address
First Line	:	11815 CAMINITO SANUDO
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92131-2103
Country	:	US
Telephone Number	:	858-549-0542
Fax Number	:	858-549-3146

Provider Business Practice Location Address
First Line	:	1415 RIDGEBACK RD STE 2
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-6983
Country	:	US
Telephone Number	:	619-656-3775
Fax Number	:	858-549-3146

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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