Provider Demographics
NPI:1740359058
Name:ULLMAN, BERNARD L (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:L
Last Name:ULLMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:520 N PROSPECT AVENUE
Mailing Address - Street 2:SUITE 309
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:310-376-9492
Mailing Address - Fax:310-376-0848
Practice Address - Street 1:520 N PROSPECT AVENUE
Practice Address - Street 2:SUITE 309
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:310-376-9492
Practice Address - Fax:310-376-0848
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG413802084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48544Medicare UPIN
G41380Medicare ID - Type Unspecified