Provider Demographics
NPI:1457446684
Name:BERMAN, BRETT JUSTIN (MD)
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:JUSTIN
Last Name:BERMAN
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:PO BOX 120847
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91912-4447
Mailing Address - Country:US
Mailing Address - Phone:619-934-3260
Mailing Address - Fax:619-934-3268
Practice Address - Street 1:321 E ST
Practice Address - Street 2:SUITE A
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-2667
Practice Address - Country:US
Practice Address - Phone:619-934-3260
Practice Address - Fax:619-934-3268
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA78854207RC0000X, 207RC0001X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI03623Medicare UPIN
CAI03623Medicare UPIN
CA00A788540Medicaid
CAA78854Medicare PIN