Provider Demographics
NPI:1750494183
Name:BERNABA, BASEM (MD)
Entity Type:Individual
Prefix:
First Name:BASEM
Middle Name:
Last Name:BERNABA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1559
Mailing Address - Street 2:1430 TRUXTON AVENUE STE 400 ATTN: ANN LEE CLINICA SIERR
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1559
Mailing Address - Country:US
Mailing Address - Phone:661-635-3050
Mailing Address - Fax:661-869-1503
Practice Address - Street 1:2400 WIBLE RD
Practice Address - Street 2:STE 14
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93304-4700
Practice Address - Country:US
Practice Address - Phone:661-835-1240
Practice Address - Fax:661-835-4667
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA88361207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
I36268Medicare UPIN
CA00A883610Medicare ID - Type Unspecified