Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A43703 | CA |
NPI | 1023064243 |
---|---|
Provider Name | David Bernal |
First Address | Pico Rivera, CA 90660-2417 |
Second Address | Pico Rivera, CA 90660-2417 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 17/03/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A437030 | (05) | CA |
00A437030 | BLUE SHIELD (01) | |
080127584 | RAILROAD (01) | CA |
520782 | HEALTH NET ID # (01) | |
E07558 | (02) | CA |
P00361841 | RAILROAD (01) | CA |