Provider Demographics
NPI:1063510501
Name:VALLEY ANESTHESIOLOGY SERVICES
Entity Type:Organization
Organization Name:VALLEY ANESTHESIOLOGY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NELSON
Authorized Official - Middle Name:
Authorized Official - Last Name:BERKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-407-2080
Mailing Address - Street 1:PO BOX 3969
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-3969
Mailing Address - Country:US
Mailing Address - Phone:562-407-2080
Mailing Address - Fax:562-407-2082
Practice Address - Street 1:47111 MONROE ST
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-6739
Practice Address - Country:US
Practice Address - Phone:562-407-2080
Practice Address - Fax:562-407-2082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2013-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062230Medicaid
CAGR0062230Medicaid