1275589608 NPI number — GABRIELLE DIONYSE LAUREN BERNARD MD

Table of content: GABRIELLE DIONYSE LAUREN BERNARD MD (NPI 1275589608)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275589608 NPI number — GABRIELLE DIONYSE LAUREN BERNARD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNARD
Provider First Name:
GABRIELLE
Provider Middle Name:
DIONYSE LAUREN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BERNARD
Provider Other First Name:
GABRIELLE
Provider Other Middle Name:
DIONY LAUREN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1275589608
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3600 LIND AVE SW
Provider Second Line Business Mailing Address:
SUITE 100 ATTN CREDENTIALING
Provider Business Mailing Address City Name:
RENTON
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98057-4970
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
425-690-2715
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1205 N 10TH ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RENTON
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98057-5577
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-690-3475
Provider Business Practice Location Address Fax Number:
425-690-9475
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  G85928 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: MD60862290 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G859280 . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 050126CG35107 . This is a "VALLEY PRES TRAILBLAZER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: G85928 . This is a "BLUE CROSS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 930123114 . This is a "VALLEY PRES RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 2106688 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G859280 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G859280 . This is a "CALOPTIMA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com