Provider Demographics
NPI:1104878073
Name:LICHTENSTEIN, BERNARD J (MD)
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:J
Last Name:LICHTENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:921 POINSETTIA AVE STE 10
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-8451
Mailing Address - Country:US
Mailing Address - Phone:760-295-9770
Mailing Address - Fax:760-598-8150
Practice Address - Street 1:8853 SPECTRUM CENTER BLVD APT 7111
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1470
Practice Address - Country:US
Practice Address - Phone:619-550-8862
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2019-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA37396207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA85006Medicare UPIN