MEDICARE: BERNARD DOUGLAS MA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	IMF78566	CA

General Provider Information

NPI Number	:	1881077485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERNARD DOUGLAS MA

Provider Business Mailing Address
First Line	:	6535 WILSHIRE BLVD
Second Line	:	SUITE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4905
Country	:	US
Telephone Number	:	213-373-1938
Fax Number	:	213-226-0556

Provider Business Practice Location Address
First Line	:	6535 WILSHIRE BLVD
Second Line	:	SUITE 103
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4905
Country	:	US
Telephone Number	:	213-373-1938
Fax Number	:	213-226-0556

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2015
Last Update Date	:	07/01/2015

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Directions to “ BERNARD DOUGLAS MA” Practice Location

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