Provider Demographics
NPI:1982655726
Name:MARCOS, BERNARDO ARISTON (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:ARISTON
Last Name:MARCOS
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 1:22647 VENTURA BLVD.
Mailing Address - Street 2:SUITE 348
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364
Mailing Address - Country:US
Mailing Address - Phone:818-225-7453
Mailing Address - Fax:818-225-7932
Practice Address - Street 1:22647 VENTURA BLVD.
Practice Address - Street 2:SUITE 348
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-225-7453
Practice Address - Fax:818-225-7932
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG38005207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology