Provider Demographics
NPI:1568419075
Name:ARASH BERELIANI, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ARASH BERELIANI, M.D., A MEDICAL CORPORATION
Other - Org Name:ARASH BERELIANI MEDICAL CORPORATION
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARASH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERELIANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-234-0105
Mailing Address - Street 1:10701 WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-4445
Mailing Address - Country:US
Mailing Address - Phone:310-234-0105
Mailing Address - Fax:310-234-0105
Practice Address - Street 1:10701 WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4401
Practice Address - Country:US
Practice Address - Phone:310-234-0105
Practice Address - Fax:310-234-0105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2009-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA066268207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A662680Medicaid
CAWA66268LMedicare PIN
CAWA66268HMedicare PIN