Basic Information
| Provider Information | |||||||||
| NPI: | 1821249376 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNARDO | ||||||||
| FirstName: | BELINDA | ||||||||
| MiddleName: | LA MADRID | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | N.P. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LA MADRID | ||||||||
| OtherFirstName: | BELINDA | ||||||||
| OtherMiddleName: | ROSE | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | N.P. | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15243 VANOWEN ST | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8187825041 | ||||||||
| FaxNumber: | 8187824864 | ||||||||
| Practice Location | |||||||||
| Address1: | 14901 RINALDI ST | ||||||||
| Address2: | SUITE 110 | ||||||||
| City: | MISSION HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913451204 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183651339 | ||||||||
| FaxNumber: | 8188984201 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2008 | ||||||||
| LastUpdateDate: | 01/03/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 17604 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.