Provider Demographics
NPI:1255471959
Name:ANGELITA S BEREDO MD INC
Entity Type:Organization
Organization Name:ANGELITA S BEREDO MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANGELITA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BEREDO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-671-2699
Mailing Address - Street 1:4220 MICHELLE DR
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-2413
Mailing Address - Country:US
Mailing Address - Phone:310-671-2699
Mailing Address - Fax:310-671-6541
Practice Address - Street 1:301 N PRAIRIE AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4507
Practice Address - Country:US
Practice Address - Phone:310-671-2699
Practice Address - Fax:310-671-6541
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A397440Medicaid
CAE88918Medicare UPIN
CA00A397440Medicaid