Provider Demographics
NPI:1538190277
Name:JAMES R BERNAVE RPT INC
Entity type:Organization
Organization Name:JAMES R BERNAVE RPT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICAL THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:R
Authorized Official - Last Name:BERNAVE
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:760-758-4770
Mailing Address - Street 1:1976 HACIENDA DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6025
Mailing Address - Country:US
Mailing Address - Phone:760-758-4770
Mailing Address - Fax:760-758-3274
Practice Address - Street 1:1976 HACIENDA DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6025
Practice Address - Country:US
Practice Address - Phone:760-758-4770
Practice Address - Fax:760-758-3274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT239174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW15040Medicare PIN