Provider Demographics
NPI:1164596169
Name:BERNSTEIN, LEONARD SAUL (MD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:SAUL
Last Name:BERNSTEIN
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 1:501 WASHINGTON STREET
Mailing Address - Street 2:SUITE 508
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2231
Mailing Address - Country:US
Mailing Address - Phone:619-299-2570
Mailing Address - Fax:619-819-7258
Practice Address - Street 1:501 WASHINGTON STREET
Practice Address - Street 2:SUITE 508
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-299-2570
Practice Address - Fax:619-819-7258
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG16410207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G164100Medicaid
CADG1942OtherPTAN
CADG1942OtherPTAN