Provider Demographics
NPI:1144664988
Name:ALBA, BERNARDINA N (MA)
Entity type:Individual
Prefix:
First Name:BERNARDINA
Middle Name:N
Last Name:ALBA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5729 NW 151ST ST STE 102
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-2481
Mailing Address - Country:US
Mailing Address - Phone:305-456-0345
Mailing Address - Fax:305-604-1515
Practice Address - Street 1:5729 NW 151ST ST STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-2481
Practice Address - Country:US
Practice Address - Phone:305-456-0345
Practice Address - Fax:305-604-1515
Is Sole Proprietor?:No
Enumeration Date:2013-04-23
Last Update Date:2013-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA 66322225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist