Provider Demographics
NPI:1992576599
Name:BERNALDO, DIANE GARCIA (FNP)
Entity type:Individual
Prefix:MRS
First Name:DIANE
Middle Name:GARCIA
Last Name:BERNALDO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:FIGUEROA
Other - Last Name:GARCIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:17809 WHEAT FIELD ST
Mailing Address - Street 2:
Mailing Address - City:LATHROP
Mailing Address - State:CA
Mailing Address - Zip Code:95330-8999
Mailing Address - Country:US
Mailing Address - Phone:209-751-7781
Mailing Address - Fax:
Practice Address - Street 1:3400 TULLY RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0803
Practice Address - Country:US
Practice Address - Phone:209-846-6440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027960363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily