Basic Information
| Provider Information | |||||||||
| NPI: | 1639604507 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARD | ||||||||
| FirstName: | RACHELLE | ||||||||
| MiddleName: | LISA | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52 N AVALON DR | ||||||||
| Address2: | |||||||||
| City: | LOS ALTOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940222315 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6506195489 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2950 S DELAWARE ST STE 150 | ||||||||
| Address2: | |||||||||
| City: | SAN MATEO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 944032591 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4152910480 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/27/2017 | ||||||||
| LastUpdateDate: | 08/29/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 08/29/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | G065841 | CA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.