Provider Demographics
NPI:1811478233
Name:BERNAL, PAOLA ESMERALDA
Entity type:Individual
Prefix:
First Name:PAOLA
Middle Name:ESMERALDA
Last Name:BERNAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 ISABELLA CIR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-4662
Mailing Address - Country:US
Mailing Address - Phone:702-689-9823
Mailing Address - Fax:
Practice Address - Street 1:4560 S EASTERN AVE STE 15
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-6182
Practice Address - Country:US
Practice Address - Phone:702-401-0811
Practice Address - Fax:702-947-6337
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-23
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist