Provider Demographics
NPI:1003023458
Name:WEST BEVERLY PODIATRY GROUP
Entity Type:Organization
Organization Name:WEST BEVERLY PODIATRY GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:323-721-6026
Mailing Address - Street 1:1601 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3931
Mailing Address - Country:US
Mailing Address - Phone:323-721-6026
Mailing Address - Fax:626-887-1891
Practice Address - Street 1:3545 GRIFFITH PARK BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-1404
Practice Address - Country:US
Practice Address - Phone:323-664-4331
Practice Address - Fax:323-664-4331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3948213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU50232Medicare UPIN