Provider Demographics
NPI:1154315000
Name:DIAMOND, BERNARD MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARD
Middle Name:MICHAEL
Last Name:DIAMOND
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 1:23101 SHERMAN PL
Mailing Address - Street 2:SUTIE 210
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-2003
Mailing Address - Country:US
Mailing Address - Phone:818-348-4110
Mailing Address - Fax:818-348-4208
Practice Address - Street 1:23101 SHERMAN PL
Practice Address - Street 2:SUTIE 210
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-2003
Practice Address - Country:US
Practice Address - Phone:818-348-4110
Practice Address - Fax:818-348-4208
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16770207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18224OtherMEDICARE SUBMITTER NUMBER
A89264Medicare UPIN
CAWG16770CMedicare PIN