Provider Demographics
NPI:1447318522
Name:BERNAL, AMPARO (MD)
Entity type:Individual
Prefix:
First Name:AMPARO
Middle Name:
Last Name:BERNAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8390 CHAMPIONSGATE BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:CHAMPIONSGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33896
Mailing Address - Country:US
Mailing Address - Phone:407-390-1677
Mailing Address - Fax:407-390-1765
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:SUITE B-122
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-383-1060
Practice Address - Fax:972-383-1061
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ7431207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139126006Medicaid
TX139126014Medicaid
TX139126017Medicaid
TX139126012Medicaid
TX139126002Medicaid
TX139126007Medicaid
TX139126005Medicaid
TX139126001Medicaid
TX139126004Medicaid
TX139126008Medicaid
TX139126003Medicaid
TX87W586OtherBCBS
TX139126016Medicaid
TX139126009Medicaid
TX139126011Medicaid
TX139126013Medicaid
87W586Medicare PIN
TX139126016Medicaid