Provider Demographics
NPI:1235926510
Name:BERNASEK, BRANDIN (PNP)
Entity type:Individual
Prefix:
First Name:BRANDIN
Middle Name:
Last Name:BERNASEK
Suffix:
Gender:
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 ALONDRA DR
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-3768
Mailing Address - Country:US
Mailing Address - Phone:503-369-1096
Mailing Address - Fax:
Practice Address - Street 1:5630 VENICE BLVD # 1137
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5127
Practice Address - Country:US
Practice Address - Phone:503-369-1096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95034742363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics