Provider Demographics
NPI:1518090760
Name:BERKENBILE, LEO E (MD)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:E
Last Name:BERKENBILE
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 1:3800 LA CRESCENTA AVE
Mailing Address - Street 2:#207
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-3924
Mailing Address - Country:US
Mailing Address - Phone:818-957-9595
Mailing Address - Fax:
Practice Address - Street 1:1812 VERDUGO BLVD
Practice Address - Street 2:VERDUGO HILLS HOSPITAL ER
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-1409
Practice Address - Country:US
Practice Address - Phone:818-952-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG31523207P00000X
UT158554-1205207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G315230Medicaid
CAWG31523GMedicare ID - Type Unspecified
A44797Medicare UPIN