Provider Demographics
NPI:1144309790
Name:BERNARDEZ, RHODA ALZATE (MD)
Entity type:Individual
Prefix:DR
First Name:RHODA
Middle Name:ALZATE
Last Name:BERNARDEZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16307 JUTEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6519
Mailing Address - Country:US
Mailing Address - Phone:562-947-4295
Mailing Address - Fax:562-947-4295
Practice Address - Street 1:17707 STUDEBAKER RD
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2640
Practice Address - Country:US
Practice Address - Phone:562-402-0688
Practice Address - Fax:562-402-3032
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA688992084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA68899OtherCA MEDICAL LICENSE
CAWA68899DOtherPPIN
CABB6422694OtherD.E.A.
CAH51842Medicare UPIN