Provider Demographics
NPI:1992806152
Name:BERNARDINO, RICARDO (MD)
Entity type:Individual
Prefix:
First Name:RICARDO
Middle Name:
Last Name:BERNARDINO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELANO
Mailing Address - State:CA
Mailing Address - Zip Code:93215-2935
Mailing Address - Country:US
Mailing Address - Phone:661-454-6511
Mailing Address - Fax:661-454-6514
Practice Address - Street 1:719 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELANO
Practice Address - State:CA
Practice Address - Zip Code:93215-2935
Practice Address - Country:US
Practice Address - Phone:661-454-6511
Practice Address - Fax:661-454-6514
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA52712207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A527120Medicaid
CA00A527120Medicaid
CA00A527120Medicare ID - Type Unspecified