Provider Demographics
NPI:1508193640
Name:BERHANE, AMAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:AMAN
Middle Name:
Last Name:BERHANE
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 1:1000 SAN GABRIEL BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-4394
Mailing Address - Country:US
Mailing Address - Phone:323-724-0019
Mailing Address - Fax:323-248-7044
Practice Address - Street 1:4126 MAINE AVE
Practice Address - Street 2:
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3306
Practice Address - Country:US
Practice Address - Phone:562-867-8681
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-10
Last Update Date:2019-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 20619363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant