Provider Demographics
NPI:1659655967
Name:BERNSTEIN, MARC (HA2988)
Entity Type:Individual
Prefix:MR
First Name:MARC
Middle Name:
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:HA2988
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 VINTAGE WAY,
Mailing Address - Street 2:SUITE K25
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94945
Mailing Address - Country:US
Mailing Address - Phone:415-892-1200
Mailing Address - Fax:
Practice Address - Street 1:208 VINTAGE WAY
Practice Address - Street 2:SUITE K25
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945
Practice Address - Country:US
Practice Address - Phone:415-892-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-05
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA2988237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist