1881603074 NPI number — DR. ROSS ALBERT BERLINER DPM

Table of content: DR. ROSS ALBERT BERLINER DPM (NPI 1881603074)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881603074 NPI number — DR. ROSS ALBERT BERLINER DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERLINER
Provider First Name:
ROSS
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881603074
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3545 GRIFFITH PARK BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90027-1404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-664-4331
Provider Business Mailing Address Fax Number:
323-664-4331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1417 W BEVERLY BLVD
Provider Second Line Business Practice Location Address:
104
Provider Business Practice Location Address City Name:
MONTEBELLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90640-4123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-721-6026
Provider Business Practice Location Address Fax Number:
323-887-1891
Provider Enumeration Date:
08/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  E3948 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000E39480 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W12208A . This is a "MEDICARE ID ARCADIA" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GRE001100 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GRE000311 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00171944 . This is a "RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W10901 . This is a "NARBONNE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 000E39482 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: GR0049330 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: WE3948G . This is a "MEDICARE PIN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GRE000310 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: DA3847 . This is a "RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: P00016205 . This is a "RAILROAD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0047500 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W11318 . This is a "AVALON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W12208 . This is a "MEDICARE ID" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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