Provider Demographics
NPI:1427015312
Name:BERNICKER, JEFFREY PHILLIP (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:PHILLIP
Last Name:BERNICKER
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 1:4180 LA JOLLA VILLAGE DRIVE. STE. 260
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:858-457-0050
Mailing Address - Fax:858-457-1911
Practice Address - Street 1:4180 LA JOLLA VILLAGE DRIVE. STE. 260
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:858-457-0050
Practice Address - Fax:858-457-1911
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70023174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA70023Medicare UPIN