Provider Demographics
NPI:1023064243
Name:BERNAL, DAVID (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:BERNAL
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 1:4941 DURFEE AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-2417
Mailing Address - Country:US
Mailing Address - Phone:562-908-3988
Mailing Address - Fax:562-692-2319
Practice Address - Street 1:4941 DURFEE AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-2417
Practice Address - Country:US
Practice Address - Phone:562-908-3988
Practice Address - Fax:562-692-2319
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2015-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43703208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A437030OtherBLUE SHIELD
CA00A437030Medicaid
CAP00361841OtherRAILROAD
520782OtherHEALTH NET ID #
CA080127584OtherRAILROAD
CA00A437030Medicaid
CAWA43703HMedicare PIN
CAWA43703JMedicare PIN
CAE07558Medicare UPIN