Provider Demographics
NPI:1598780736
Name:NG, BERNARDO (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2417 MARSHALL AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:IMPERIAL
Mailing Address - State:CA
Mailing Address - Zip Code:92251
Mailing Address - Country:US
Mailing Address - Phone:760-355-0161
Mailing Address - Fax:760-355-2596
Practice Address - Street 1:2417 MARSHALL AVE
Practice Address - Street 2:STE 1
Practice Address - City:IMPERIAL
Practice Address - State:CA
Practice Address - Zip Code:92251
Practice Address - Country:US
Practice Address - Phone:760-355-0161
Practice Address - Fax:760-355-2596
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA487742084P0800X, 2084A0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF60695Medicare UPIN