Provider Demographics
NPI:1760683684
Name:BERNIER LEON, DOMINGO ALBERTO (MD)
Entity Type:Individual
Prefix:DR
First Name:DOMINGO
Middle Name:ALBERTO
Last Name:BERNIER LEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5075
Mailing Address - Street 2:
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00984-5075
Mailing Address - Country:US
Mailing Address - Phone:787-236-3066
Mailing Address - Fax:787-946-9705
Practice Address - Street 1:33B AVE CAMPO RICO GK
Practice Address - Street 2:URB COUNTRY CLUB
Practice Address - City:CAROLINA
Practice Address - State:PR
Practice Address - Zip Code:00982
Practice Address - Country:US
Practice Address - Phone:787-946-3322
Practice Address - Fax:787-946-9705
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR15547208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PRI-48154Medicare UPIN
PR2-3759Medicare ID - Type Unspecified