Healthcare Provider Details

I. General information

NPI: 1649464587
Provider Name (Legal Business Name): JOHN H BERNHARDT RN, PHN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 02/26/2026
Certification Date: 02/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 PETER BEHR DR
SAN RAFAEL CA
94903-5299
US

IV. Provider business mailing address

13 PETER BEHR DR
SAN RAFAEL CA
94903-5299
US

V. Phone/Fax

Practice location:
  • Phone: 415-473-6651
  • Fax: 415-473-7505
Mailing address:
  • Phone: 415-473-6651
  • Fax: 415-473-7505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License Number566518
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number720091
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: