Provider Demographics
NPI:1407836323
Name:BERNAT, AVIVA S (MD)
Entity Type:Individual
Prefix:
First Name:AVIVA
Middle Name:S
Last Name:BERNAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#1046
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5784
Mailing Address - Country:US
Mailing Address - Phone:323-251-4546
Mailing Address - Fax:413-403-4078
Practice Address - Street 1:2001 S BARRINGTON AVE
Practice Address - Street 2:#116
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5363
Practice Address - Country:US
Practice Address - Phone:310-728-6193
Practice Address - Fax:413-403-4078
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2008-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA98681207R00000X, 207RH0002X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO39373843Medicaid
AZ914491Medicaid
NM72670045Medicaid
8HD19SMedicare ID - Type Unspecified
AZ914491Medicaid