Healthcare Provider Details

I. General information

NPI: 1346460433
Provider Name (Legal Business Name): ROBERT MARTIN BERNSTEIN CCP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3833 PARK BLVD APT #1
PALO ALTO CA
94306-3490
US

IV. Provider business mailing address

3833 PARK BLVD APT #1
PALO ALTO CA
94306-3490
US

V. Phone/Fax

Practice location:
  • Phone: 650-815-8909
  • Fax: 650-615-9995
Mailing address:
  • Phone: 650-815-8909
  • Fax: 650-615-9995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code242T00000X
TaxonomyPerfusionist
License Number800208
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: