Provider Demographics
NPI:1902123060
Name:BERNARDO, DANILO REYES JR (MD)
Entity Type:Individual
Prefix:
First Name:DANILO
Middle Name:REYES
Last Name:BERNARDO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE STE 22-474
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-6196
Mailing Address - Fax:310-825-5834
Practice Address - Street 1:10833 LE CONTE AVE STE 22-474
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-4221
Practice Address - Country:US
Practice Address - Phone:310-825-6196
Practice Address - Fax:310-825-5834
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC165210390200000X
CAA1310832084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program