Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YS0123X | Facial Plastic Surgeon | A00026367 | CA |
NPI | 1265435945 |
---|---|
Provider Name | Dr. Philip Bernstein |
First Address | Sacramento, CA 95815-4314 |
Second Address | Sacramento, CA 95815-4314 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/05/2005 |
Last Update Date | 07/05/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040007476 | RR MEDICARE PIN (01) | CA |
A50507 | (02) |