Provider Demographics
NPI:1609636695
Name:BERNARDI MEDICAL GROUP PLLC
Entity Type:Organization
Organization Name:BERNARDI MEDICAL GROUP PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-997-9105
Mailing Address - Street 1:905 DALTON DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89119-4803
Mailing Address - Country:US
Mailing Address - Phone:858-997-9105
Mailing Address - Fax:
Practice Address - Street 1:905 DALTON DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-4803
Practice Address - Country:US
Practice Address - Phone:858-997-9105
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive MedicineGroup - Multi-Specialty