Provider Demographics
NPI:1164549077
Name:BERLOW, RUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:RUSTIN
Middle Name:
Last Name:BERLOW
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 1:1104 CAMINO DEL MAR
Mailing Address - Street 2:STE 10
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014
Mailing Address - Country:US
Mailing Address - Phone:619-894-4489
Mailing Address - Fax:619-330-1804
Practice Address - Street 1:1104 CAMINO DEL MAR
Practice Address - Street 2:STE 10
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014
Practice Address - Country:US
Practice Address - Phone:619-894-4489
Practice Address - Fax:619-330-1804
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2016-05-20
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-09-19
Provider Licenses
StateLicense IDTaxonomies
CAG769452084P0800X
CAG0769452084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry