Provider Demographics
NPI:1003966763
Name:BERNADETT, FAUSTINO (MD)
Entity Type:Individual
Prefix:DR
First Name:FAUSTINO
Middle Name:
Last Name:BERNADETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 ELM AVE
Mailing Address - Street 2:100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-3264
Mailing Address - Country:US
Mailing Address - Phone:562-491-2145
Mailing Address - Fax:562-799-3721
Practice Address - Street 1:1040 ELM AVE
Practice Address - Street 2:100
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3264
Practice Address - Country:US
Practice Address - Phone:562-491-2145
Practice Address - Fax:562-799-3721
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2008-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44925207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA49810Medicare UPIN