Healthcare Provider Details

I. General information

NPI: 1124646906
Provider Name (Legal Business Name): JEFFREY DAVID BERNSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2020
Last Update Date: 06/11/2025
Certification Date: 06/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC 1234
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

200 W ARBOR DR MC 1234
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax: 619-543-5521
Mailing address:
  • Phone: 619-543-1967
  • Fax: 619-543-5521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA186073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: