Provider Demographics
NPI:1225579352
Name:PAREDES, BERNADETTE (LVN)
Entity type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:PAREDES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:256 S ROYAL OAK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92114-7414
Mailing Address - Country:US
Mailing Address - Phone:619-917-5715
Mailing Address - Fax:
Practice Address - Street 1:256 S ROYAL OAK DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-7414
Practice Address - Country:US
Practice Address - Phone:619-917-5715
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN 277135164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse