Basic Information
Provider Information
NPI: 1558622522
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BERNAL
FirstName: NATHAN
MiddleName: J
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 11130 CHRISTUS HILLS
Address2: 2ND FLOOR, SUITE 201
City: SAN ANTONIO
State: TX
PostalCode: 782513584
CountryCode: US
TelephoneNumber: 2107039045
FaxNumber: 2107039009
Practice Location
Address1: 11130 CHRISTUS HILLS
Address2: 3RD FLOOR
City: SAN ANTONIO
State: TX
PostalCode: 782513584
CountryCode: US
TelephoneNumber: 2107039001
FaxNumber: 2107039155
Other Information
ProviderEnumerationDate: 06/06/2012
LastUpdateDate: 10/13/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 10/13/2022

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
208M00000XQ5618TXN Allopathic & Osteopathic PhysiciansHospitalist 
207Q00000XQ5618TXY Allopathic & Osteopathic PhysiciansFamily Medicine 

No ID Information.


Home