Provider Demographics
NPI:1396429924
Name:LEPE, BERNARDO JR (AA)
Entity type:Individual
Prefix:
First Name:BERNARDO
Middle Name:
Last Name:LEPE
Suffix:JR
Gender:M
Credentials:AA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3766 CASTLE OAK DR.
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3615
Mailing Address - Country:US
Mailing Address - Phone:323-353-1678
Mailing Address - Fax:
Practice Address - Street 1:3766 CASTLE OAK DR.
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-3615
Practice Address - Country:US
Practice Address - Phone:323-353-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician