Provider Demographics
NPI:1750485777
Name:BERNSTEIN, RICHARD A (DO)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:BERNSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:4170 GROSS ROAD EXT
Mailing Address - Street 2:STE 6
Mailing Address - City:CAPITOLA
Mailing Address - State:CA
Mailing Address - Zip Code:95010-2054
Mailing Address - Country:US
Mailing Address - Phone:561-241-9300
Mailing Address - Fax:561-515-8865
Practice Address - Street 1:4400 CAPITOLA RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CAPITOLA
Practice Address - State:CA
Practice Address - Zip Code:95010-3571
Practice Address - Country:US
Practice Address - Phone:408-364-6799
Practice Address - Fax:408-378-4510
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2017-01-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6688208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77-0458316OtherTAX ID
CA77-0458316OtherTAX ID
CACA104434Medicare PIN
CA020A66880Medicare ID - Type UnspecifiedMEDICARE INDIVID
CAG08482Medicare UPIN