Provider Demographics
NPI:1437869765
Name:BERMAN, TYLER MATTHEW (PA-C)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:MATTHEW
Last Name:BERMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 FUENTE
Mailing Address - Street 2:
Mailing Address - City:RCHO STA MARG
Mailing Address - State:CA
Mailing Address - Zip Code:92688-3021
Mailing Address - Country:US
Mailing Address - Phone:714-768-4157
Mailing Address - Fax:
Practice Address - Street 1:11800 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6602
Practice Address - Country:US
Practice Address - Phone:310-231-2121
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-28
Last Update Date:2023-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant