Provider Demographics
NPI:1326038217
Name:BERNARDO, ANGELA M (OD)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:M
Last Name:BERNARDO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8353 GEORGETOWN AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-2612
Mailing Address - Country:US
Mailing Address - Phone:310-310-5842
Mailing Address - Fax:
Practice Address - Street 1:8353 GEORGETOWN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-2612
Practice Address - Country:US
Practice Address - Phone:310-310-5842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14820152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3935SMedicare PIN
FLU7977Medicare UPIN