Provider Demographics
NPI:1215027446
Name:RABIN BERAL DPM A PODIATRY CORPORATION
Entity Type:Organization
Organization Name:RABIN BERAL DPM A PODIATRY CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RABIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BERAL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:310-515-8155
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 302
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3583
Mailing Address - Country:US
Mailing Address - Phone:310-515-8155
Mailing Address - Fax:310-515-8833
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:STE 302
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3583
Practice Address - Country:US
Practice Address - Phone:310-515-8155
Practice Address - Fax:310-515-8833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-16
Last Update Date:2016-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5185000001Medicare NSC
CAU98722Medicare UPIN
CAW17911AMedicare PIN
CA6141550001Medicare NSC