Healthcare Provider Details

I. General information

NPI: 1124655816
Provider Name (Legal Business Name): MARC STEVEN BERNS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2020
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7901 FROST ST
SAN DIEGO CA
92123-2701
US

IV. Provider business mailing address

9655 GRANITE RIDGE DR STE 200
SAN DIEGO CA
92123-2676
US

V. Phone/Fax

Practice location:
  • Phone: 858-939-3600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA210725
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number1022861
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: