Healthcare Provider Details

I. General information

NPI: 1639173974
Provider Name (Legal Business Name): BERNARD J URLAUB M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 RESERVOIR DR. STE. 206
SAN DIEGO CA
92120-5101
US

IV. Provider business mailing address

5555 RESERVOIR DR. STE. 206
SAN DIEGO CA
92120-5101
US

V. Phone/Fax

Practice location:
  • Phone: 619-287-6003
  • Fax: 619-287-6038
Mailing address:
  • Phone: 619-287-6003
  • Fax: 619-287-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberC33988
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: