Healthcare Provider Details

I. General information

NPI: 1619213998
Provider Name (Legal Business Name): KEVIN BERNSTEIN MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2012
Last Update Date: 04/22/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

391 FYNN VALLEY DR
LAS VEGAS NV
89148-4454
US

IV. Provider business mailing address

391 FYNN VALLEY DR
LAS VEGAS NV
89148-4454
US

V. Phone/Fax

Practice location:
  • Phone: 702-405-9080
  • Fax:
Mailing address:
  • Phone: 702-506-3139
  • Fax: 702-259-0205

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number9507
License Number StateNV

VIII. Authorized Official

Name: KEVIN BERNSTEIN
Title or Position: OWNER
Credential: MD
Phone: 702-813-8079