1699025981 NPI number — MARIA GONZALEZ BERLARI, MD LLC

Table of content: (NPI 1699025981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699025981 NPI number — MARIA GONZALEZ BERLARI, MD LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARIA GONZALEZ BERLARI, MD LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1699025981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
202 E EARLL DR STE 360
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85012-2677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-240-5613
Provider Business Mailing Address Fax Number:
480-205-1063

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9150 W INDIAN SCHOOL ROAD, BUILDING 5
Provider Second Line Business Practice Location Address:
SUITE 118
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
623-247-5700
Provider Business Practice Location Address Fax Number:
623-849-0717
Provider Enumeration Date:
09/13/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KIM
Authorized Official First Name:
KIUP
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
480-323-6072

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  41464 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 923132 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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