Provider Demographics
NPI:1376851428
Name:GEORGE A. BERNALES, M.D.,INC.
Entity Type:Organization
Organization Name:GEORGE A. BERNALES, M.D.,INC.
Other - Org Name:CLINICA MEDICA BERNALES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:ASIS
Authorized Official - Last Name:BERNALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:323-583-2718
Mailing Address - Street 1:5235 DAHLIA DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90041-1406
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2766 E FLORENCE AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON PARK
Practice Address - State:CA
Practice Address - Zip Code:90255-5747
Practice Address - Country:US
Practice Address - Phone:323-583-2718
Practice Address - Fax:323-583-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-22
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA47861261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A478611Medicaid
CA00A478611Medicaid
CAA47861Medicare PIN