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General NPI Number Information
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NPI Number | 1851595227
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Entity Type | Organization
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Legal Business Name | BERNARD MONDERER, MD, INC.
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 15211 VANOWEN ST SUITE 210
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City | VAN NUYS
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State | CA
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Zip | 91405-3606
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Country | US
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Telephone | 818-786-0710
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Fax | 818-786-0712
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Provider Business Mailing Address
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Address Line | 15211 VANOWEN ST SUITE 210
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City | VAN NUYS
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State | CA
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Zip | 91405-3606
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Country | US
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Telephone | 818-786-0710
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Fax | 818-786-0712
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Authorized Official
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Title or Position | MD
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Name | DR. BERNARD MONDERER
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Credential | MD
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Telephone | 818-786-0710
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G34153
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License Number State | CA
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