Provider Demographics
NPI:1104823285
Name:BERUTI, BERUTI I (MD)
Entity Type:Individual
Prefix:DR
First Name:BERUTI
Middle Name:I
Last Name:BERUTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3267 SITIO TORTUGA
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-2007
Mailing Address - Country:US
Mailing Address - Phone:760-421-8251
Mailing Address - Fax:
Practice Address - Street 1:3267 SITIO TORTUGA
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-2007
Practice Address - Country:US
Practice Address - Phone:760-421-8251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35100077B207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268035Medicaid
0415921Medicare ID - Type Unspecified
C01248Medicare UPIN