Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QS0010X | Family Doctor - Sports Medicine | MD60855690 | WA |
NPI | 1215382841 |
---|---|
Provider Name | Alex Bernadett |
First Address | San Diego, CA 92121-1433 |
Second Address | San Diego, CA 92121-1433 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/05/2016 |
Last Update Date | 01/07/2019 |