Healthcare Provider Details

I. General information

NPI: 1053547075
Provider Name (Legal Business Name): BOB NAIM BERNABA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2009
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 GENESEE AVE
SAN DIEGO CA
92123-4219
US

IV. Provider business mailing address

2020 GENESEE AVE
SAN DIEGO CA
92123-4219
US

V. Phone/Fax

Practice location:
  • Phone: 858-616-8033
  • Fax:
Mailing address:
  • Phone: 858-616-8033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberA103834
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207ZP0105X
TaxonomyClinical Pathology/Laboratory Medicine Physician
License NumberA103834
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: