Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207U00000X | Nuclear Medicine Specialist | A66845 | CA |
NPI | 1780635508 |
---|---|
Provider Name | Mark Steven Bernard |
First Address | Novato, CA 94948-6102 |
Second Address | Fresno, CA 93720-3309 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/05/2006 |
Last Update Date | 12/01/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A668450 | (05) | CA |
360004327 | RAILROAD MEDICARE PIN (01) | |
H27582 | (02) |