Provider Demographics
NPI:1316910177
Name:LAXA, BERNADETTE UY (MD)
Entity type:Individual
Prefix:MS
First Name:BERNADETTE
Middle Name:UY
Last Name:LAXA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:BERNADETTE
Other - Middle Name:U
Other - Last Name:LAXA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:26301 PEACOCK PL.
Mailing Address - Street 2:
Mailing Address - City:STEVENSON RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:91381
Mailing Address - Country:US
Mailing Address - Phone:818-288-4200
Mailing Address - Fax:
Practice Address - Street 1:9400 E. ROSECRANS AVE.
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706
Practice Address - Country:US
Practice Address - Phone:562-461-3345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2021-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ36036208600000X
CAA121181208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery