Healthcare Provider Details

I. General information

NPI: 1366705212
Provider Name (Legal Business Name): JONATHAN BERNSTEIN, MD, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S MARYLAND PKWY 206
LAS VEGAS NV
89109-2307
US

IV. Provider business mailing address

3121 S MARYLAND PKWY SUITE 302
LAS VEGAS NV
89109-2307
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-1956
  • Fax: 702-732-3225
Mailing address:
  • Phone: 702-732-1493
  • Fax: 702-732-1404

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207SG0201X
TaxonomyClinical Genetics (M.D.) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2080P0216X
TaxonomyPediatric Rheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. ANNETTE LOGAN
Title or Position: PRESIDENT
Credential:
Phone: 702-732-0232