Healthcare Provider Details

I. General information

NPI: 1578736633
Provider Name (Legal Business Name): IRWIN B BERNHARDT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2008
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1157 SNOWBERRY COURT
SUNNYVALE CA
94087-2477
US

IV. Provider business mailing address

1157 SNOWBERRY COURT
SUNNYVALE CA
94087-2477
US

V. Phone/Fax

Practice location:
  • Phone: 408-739-5407
  • Fax:
Mailing address:
  • Phone: 408-739-5407
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberGFE7576
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: