1407836323 NPI number — AVIVA S BERNAT M.D.

Table of content: AVIVA S BERNAT M.D. (NPI 1407836323)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407836323 NPI number — AVIVA S BERNAT M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERNAT
Provider First Name:
AVIVA
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407836323
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2118 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
#1046
Provider Business Mailing Address City Name:
SANTA MONICA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90403-5784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-251-4546
Provider Business Mailing Address Fax Number:
413-403-4078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 S BARRINGTON AVE
Provider Second Line Business Practice Location Address:
#116
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-5363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-728-6193
Provider Business Practice Location Address Fax Number:
413-403-4078
Provider Enumeration Date:
01/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  A98681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0002X , with the licence number: A98681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: A98681 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 39373843 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 914491 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72670045 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".