Provider Demographics
NPI:1992439228
Name:BERNAL, ERICA YANET
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:YANET
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 1:32 N 121ST EAST AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74116-3838
Mailing Address - Country:US
Mailing Address - Phone:918-798-8328
Mailing Address - Fax:
Practice Address - Street 1:32 N 121ST EAST AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74116-3838
Practice Address - Country:US
Practice Address - Phone:918-798-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-12
Last Update Date:2022-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist