Provider Demographics
NPI:1841367471
Name:BERNHUT, ANNETTE C (DO)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:C
Last Name:BERNHUT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2010-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5094207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A5094OtherSTATE LICENSE NUMBER
CA20A5094AMedicare ID - Type Unspecified
CA20A5094OtherSTATE LICENSE NUMBER