Basic Information
| Provider Information | |||||||||
| NPI: | 1174164412 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARD | ||||||||
| FirstName: | JOELLA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 E SAN FERNANDO ST PH 17 | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951127419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082926835 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 438 N WHITE RD | ||||||||
| Address2: | |||||||||
| City: | SAN JOSE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 951271439 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4082546848 | ||||||||
| FaxNumber: | 4082546838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2019 | ||||||||
| LastUpdateDate: | 10/07/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 492144 | CA | Y | Nursing Service Providers | Registered Nurse | Psych/Mental Health |
No ID Information.