Healthcare Provider Details

I. General information

NPI: 1619097714
Provider Name (Legal Business Name): JORGE BERNARDEZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDONDO AVE SUITE 5
LONG BEACH CA
90806-2325
US

IV. Provider business mailing address

2600 REDONDO AVE SUITE 5
LONG BEACH CA
90806-2325
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0085
  • Fax: 562-933-0088
Mailing address:
  • Phone: 562-933-0085
  • Fax: 562-933-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083P0500X
TaxonomyPreventive Medicine/Occupational Environmental Medicine Physician
License NumberA45913
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: