Provider Demographics
NPI:1023213949
Name:NARBONNE MEDICAL GROUP
Entity Type:Organization
Organization Name:NARBONNE MEDICAL 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:
Authorized Official - Last Name:BERLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-325-0600
Mailing Address - Street 1:3545 GRIFFITH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1404
Mailing Address - Country:US
Mailing Address - Phone:323-664-4331
Mailing Address - Fax:323-664-4331
Practice Address - Street 1:24845 NARBONNE AVE
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-1549
Practice Address - Country:US
Practice Address - Phone:310-325-0600
Practice Address - Fax:310-325-0346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
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 - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU50232Medicare UPIN