Provider Demographics
NPI:1346460433
Name:BERNSTEIN, ROBERT MARTIN (CCP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:CCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 PARK BLVD
Mailing Address - Street 2:APT #1
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-3490
Mailing Address - Country:US
Mailing Address - Phone:650-815-8909
Mailing Address - Fax:650-615-9995
Practice Address - Street 1:3833 PARK BLVD
Practice Address - Street 2:APT #1
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-3490
Practice Address - Country:US
Practice Address - Phone:650-815-8909
Practice Address - Fax:650-615-9995
Is Sole Proprietor?:No
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA800208242T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes242T00000XTechnologists, Technicians & Other Technical Service ProvidersPerfusionist