1447318522 NPI number — AMPARO BERNAL MD

Table of content: AMPARO BERNAL MD (NPI 1447318522)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447318522 NPI number — AMPARO BERNAL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNAL
Provider First Name:
AMPARO
Provider Middle Name:
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:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447318522
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8390 CHAMPIONSGATE BLVD
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
CHAMPIONSGATE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33896
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-390-1677
Provider Business Mailing Address Fax Number:
407-390-1765

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7777 FOREST LN
Provider Second Line Business Practice Location Address:
SUITE B-122
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75230-2571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-383-1060
Provider Business Practice Location Address Fax Number:
972-383-1061
Provider Enumeration Date:
12/04/2006

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: 207R00000X , with the licence number:  J7431 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 139126006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126014 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126017 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126012 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87W586 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 139126016 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126009 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126011 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 139126013 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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