Provider Demographics
NPI:1013647627
Name:ALEPH MEDICAL
Entity Type:Organization
Organization Name:ALEPH MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:A
Authorized Official - Last Name:BERTRAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-739-8309
Mailing Address - Street 1:13273 FIJI WAY
Mailing Address - Street 2:STE 315
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-7093
Mailing Address - Country:US
Mailing Address - Phone:310-739-8309
Mailing Address - Fax:
Practice Address - Street 1:13273 FIJI WAY
Practice Address - Street 2:#315
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-7093
Practice Address - Country:US
Practice Address - Phone:310-739-8309
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-15
Last Update Date:2022-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1700220647Medicaid