Provider Demographics
NPI:1164540118
Name:BERMANI, JAWAD (MD)
Entity Type:Individual
Prefix:DR
First Name:JAWAD
Middle Name:
Last Name:BERMANI
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:PO BOX 2888
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2888
Mailing Address - Country:US
Mailing Address - Phone:661-948-4571
Mailing Address - Fax:
Practice Address - Street 1:44725 10TH ST W
Practice Address - Street 2:# 120
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3033
Practice Address - Country:US
Practice Address - Phone:661-948-4571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39444208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A394440Medicaid
CAA 28889Medicare UPIN
CA00A394440Medicaid