Provider Demographics
NPI:1558654509
Name:BERANEK, CHRISTY (PA)
Entity Type:Individual
Prefix:
First Name:CHRISTY
Middle Name:
Last Name:BERANEK
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:433 E WARDLOW RD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4507
Mailing Address - Country:US
Mailing Address - Phone:562-427-0550
Mailing Address - Fax:562-988-8899
Practice Address - Street 1:433 E WARDLOW RD
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4507
Practice Address - Country:US
Practice Address - Phone:562-427-0550
Practice Address - Fax:562-988-8899
Is Sole Proprietor?:No
Enumeration Date:2011-05-24
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant