Provider Demographics
NPI:1114937547
Name:BERDOS, ANDREW CABAL (PT)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:CABAL
Last Name:BERDOS
Suffix:
Gender:M
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:153 N DILLON ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-4617
Mailing Address - Country:US
Mailing Address - Phone:510-402-3054
Mailing Address - Fax:
Practice Address - Street 1:1212 S FLOWER ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-2123
Practice Address - Country:US
Practice Address - Phone:213-747-0634
Practice Address - Fax:213-741-9478
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT30277225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist