Provider Demographics
NPI:1194850446
Name:EMMETT BERG DO INC. AND HOLVEY MEDICAL GROUP INC.
Entity Type:Organization
Organization Name:EMMETT BERG DO INC. AND HOLVEY MEDICAL GROUP INC.
Other - Org Name:HEALTHLINE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:RITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-997-7711
Mailing Address - Street 1:15211 VANOWEN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3606
Mailing Address - Country:US
Mailing Address - Phone:818-997-7711
Mailing Address - Fax:818-997-3744
Practice Address - Street 1:15211 VANOWEN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3606
Practice Address - Country:US
Practice Address - Phone:818-997-7711
Practice Address - Fax:818-997-3744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty