| Doctor Name: | DR. WILSON FULLA BERNALES |
| NPI Number: | 1508824467 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | C1-0007844 |
| Business Practice Address: | 118 E Haskell St Winnemucca, NV - 894453247 |
| Business Phone Number: | 4795307169 |
| Business Fax Number: | 7756253084 |
| Mailing Address: | Po Box 17577, JACKSONVILLE |
| State: | FL |
| Postal Code: | 322457577 |
| Phone Number: | 9043991623 |
| Fax Number: | 9043991624 |
| NPI Enumeration Date: | 05/02/2006 |
| NPI Last Update Date: | 12/17/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 207QA0505X |
| License Number: | C1-0007844 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | DE |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Family Medicine |
| Taxonomy Specialization: | Adult Medicine |
| Taxonomy Definition: | |