Provider Demographics
NPI:1104838754
Name:BERNSTEIN, LAWRENCE GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:LAWRENCE
Middle Name:GREGORY
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 9602
Mailing Address - Street 2:
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91346-9602
Mailing Address - Country:US
Mailing Address - Phone:818-837-5691
Mailing Address - Fax:818-792-4793
Practice Address - Street 1:27924 SECO CANYON RD
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91350-3870
Practice Address - Country:US
Practice Address - Phone:661-513-2100
Practice Address - Fax:661-513-2105
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71974207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G719740Medicaid
CA00G719740Medicaid
CAF41955Medicare UPIN