Provider Demographics
NPI:1104033901
Name:JILL R. BERLIN, DPM INC
Entity Type:Organization
Organization Name:JILL R. BERLIN, DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO,PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JILL
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:BERLIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:949-581-2944
Mailing Address - Street 1:PO BOX 146
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92609-0146
Mailing Address - Country:US
Mailing Address - Phone:949-581-2944
Mailing Address - Fax:949-768-2647
Practice Address - Street 1:26912 CARRANZA DR
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-5002
Practice Address - Country:US
Practice Address - Phone:949-581-2944
Practice Address - Fax:949-768-2647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3871213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU39928Medicare UPIN