Provider Demographics
NPI:1649325051
Name:FLASTERSTEIN, BERNARDO (M D)
Entity type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:
Last Name:FLASTERSTEIN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12959 PALMS WEST DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-4937
Mailing Address - Country:US
Mailing Address - Phone:561-753-8888
Mailing Address - Fax:561-795-5004
Practice Address - Street 1:12959 PALMS WEST DR
Practice Address - Street 2:SUITE 120
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-4937
Practice Address - Country:US
Practice Address - Phone:561-753-8888
Practice Address - Fax:561-795-5004
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO1164962080P0008X
FLME1112652084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004507500Medicaid
MOF41194Medicare UPIN
FL004507500Medicaid