Provider Demographics
NPI:1114320652
Name:PUA, BERNADETTE LOURDES TORRES (NP)
Entity type:Individual
Prefix:
First Name:BERNADETTE LOURDES
Middle Name:TORRES
Last Name:PUA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10037 FAIRWEATHER DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7028
Mailing Address - Country:US
Mailing Address - Phone:209-373-3907
Mailing Address - Fax:
Practice Address - Street 1:5320 CARRINGTON CIR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-3515
Practice Address - Country:US
Practice Address - Phone:209-473-3004
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95019689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily