Provider Demographics
NPI:1487869558
Name:MARK BERNHARD, D.O. INC.
Entity type:Organization
Organization Name:MARK BERNHARD, D.O. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BERNHARD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:626-584-1112
Mailing Address - Street 1:1060 E GREEN ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-2413
Mailing Address - Country:US
Mailing Address - Phone:626-584-1112
Mailing Address - Fax:626-584-0453
Practice Address - Street 1:1060 E GREEN ST
Practice Address - Street 2:SUITE 107
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-2413
Practice Address - Country:US
Practice Address - Phone:626-584-1112
Practice Address - Fax:626-584-0453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4471261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A4471OtherLICENSE
CA20A4471OtherLICENSE