Healthcare Provider Details

I. General information

NPI: 1962081208
Provider Name (Legal Business Name): SHAWNA BERNSTEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21515 HAWTHORNE BLVD STE GL-100
TORRANCE CA
90503-6501
US

IV. Provider business mailing address

5132 MERRILL ST
TORRANCE CA
90503-6862
US

V. Phone/Fax

Practice location:
  • Phone: 424-571-2618
  • Fax:
Mailing address:
  • Phone: 310-489-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: