Provider Demographics
NPI: | 1336442250 |
---|---|
Name: | ANNETTE BERNHUT D O INC. |
Entity Type: | Organization |
Organization Name: | ANNETTE BERNHUT D O INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | ANNETTE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | BERNHUT |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DO |
Authorized Official - Phone: | 714-997-2899 |
Mailing Address - Street 1: | 845 E CHAPMAN AVE |
Mailing Address - Street 2: | |
Mailing Address - City: | ORANGE |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92866-1622 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-997-2899 |
Mailing Address - Fax: | 714-289-7062 |
Practice Address - Street 1: | 845 E CHAPMAN AVE |
Practice Address - Street 2: | |
Practice Address - City: | ORANGE |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92866-1622 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-997-2899 |
Practice Address - Fax: | 714-289-7062 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-12-15 |
Last Update Date: | 2010-12-15 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CA | 20A5094 | 207Q00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Single Specialty |