Basic Information
| Provider Information | |||||||||
| NPI: | 1164596169 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BERNSTEIN | ||||||||
| FirstName: | LEONARD | ||||||||
| MiddleName: | SAUL | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 WASHINGTON STREET | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192992570 | ||||||||
| FaxNumber: | 6198197258 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 WASHINGTON STREET | ||||||||
| Address2: | SUITE 508 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921032231 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192992570 | ||||||||
| FaxNumber: | 6198197258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 02/22/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | G16410 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G164100 | 05 | CA | MEDICAID | DG1942 | 01 | CA | PTAN | OTHER |