Provider Demographics
NPI:1902087224
Name:BERNARDO, JUNNE MORADA (IDC)
Entity Type:Individual
Prefix:MR
First Name:JUNNE
Middle Name:MORADA
Last Name:BERNARDO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 LOUISIANA ST
Mailing Address - Street 2:
Mailing Address - City:CAMP LEJEUNE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-1222
Mailing Address - Country:US
Mailing Address - Phone:760-390-7767
Mailing Address - Fax:
Practice Address - Street 1:5730 LOUISIANA ST
Practice Address - Street 2:
Practice Address - City:CAMP LEJEUNE
Practice Address - State:NC
Practice Address - Zip Code:28547-1222
Practice Address - Country:US
Practice Address - Phone:760-390-7767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-15
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman