Healthcare Provider Details

I. General information

NPI: 1831282151
Provider Name (Legal Business Name): JONATHAN BERNSTEIN MD LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2006
Last Update Date: 06/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3121 S MARYLAND PKWY STE 300
LAS VEGAS NV
89109-2307
US

IV. Provider business mailing address

3121 S MARYLAND PKWY STE 300
LAS VEGAS NV
89109-2307
US

V. Phone/Fax

Practice location:
  • Phone: 702-732-1493
  • Fax: 702-732-1080
Mailing address:
  • Phone: 702-732-1493
  • Fax: 702-732-1080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: JONATHAN BERNSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 702-734-1493