Provider Demographics
NPI:1033119250
Name:BERKLEY, JASON A (DO)
Entity Type:Individual
Prefix:DR
First Name:JASON
Middle Name:A
Last Name:BERKLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:122 SHELDON ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3915
Mailing Address - Country:US
Mailing Address - Phone:310-322-4278
Mailing Address - Fax:310-322-6660
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:800
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9900
Practice Address - Fax:310-423-9965
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A8006208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABW293ZMedicare PIN