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General NPI Number Information
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NPI Number | 1679693923
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Entity Type | Organization
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Legal Business Name | BERNARD GOTTLIEB MD INC
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 09/26/2008
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Provider Practice Location Address
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Address Line | 1666 N WATERMAN AVE
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City | SAN BERNARDINO
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State | CA
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Zip | 92404-5113
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Country | US
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Telephone | 888-700-0881
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 10517
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City | SAN BERNARDINO
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State | CA
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Zip | 92423-0517
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Country | US
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Telephone | 888-400-0881
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Fax |
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Authorized Official
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Title or Position | PATHOLOGIST
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Name | DR. BERNARD GOTTLIEB
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Credential | M.D.
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Telephone | 888-700-0881
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | C19354
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License Number State | CA
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