Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 20A4471 | CA |
NPI | 1386719904 |
---|---|
Provider Name | Dr. Mark Douglas Bernhard |
First Address | Pasadena, CA 91106-2413 |
Second Address | Pasadena, CA 91106-2413 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A93583 | (02) | CA |