1457506594 NPI number — MR. RUDOLFO J BERRU MA.,LMFT,CEAP

Table of content: MR. RUDOLFO J BERRU MA.,LMFT,CEAP (NPI 1457506594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457506594 NPI number — MR. RUDOLFO J BERRU MA.,LMFT,CEAP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BERRU
Provider First Name:
RUDOLFO
Provider Middle Name:
J
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MA.,LMFT,CEAP
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:
1457506594
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 S VENICE BLVD APT 2
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VENICE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90291-4674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-306-9082
Provider Business Mailing Address Fax Number:
323-586-3988

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 S VENICE BLVD APT 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VENICE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90291-4674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-306-9082
Provider Business Practice Location Address Fax Number:
323-586-2615
Provider Enumeration Date:
11/17/2008

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: 106H00000X , with the licence number:  LMFT #43334 , 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)





Copyright © 2007-2025 www.npivalidator.com