Provider Demographics
NPI:1396740999
Name:MARISTANY, BERNARD G (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:G
Last Name:MARISTANY
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 1:2301 BAHAMAS DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0663
Mailing Address - Country:US
Mailing Address - Phone:661-395-3272
Mailing Address - Fax:661-334-3065
Practice Address - Street 1:2301 BAHAMAS DR
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0663
Practice Address - Country:US
Practice Address - Phone:661-395-3272
Practice Address - Fax:661-334-3065
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA946792085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1680338Medicaid
H47683Medicare UPIN
LA1680338Medicaid
CAH47683Medicare UPIN