Provider Demographics
NPI:1578561502
Name:BERLIOZ, DEANA (CRNA)
Entity Type:Individual
Prefix:
First Name:DEANA
Middle Name:
Last Name:BERLIOZ
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:DEANA
Other - Middle Name:
Other - Last Name:JOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4140 W 190TH ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90504-5513
Mailing Address - Country:US
Mailing Address - Phone:310-423-1447
Mailing Address - Fax:310-423-0387
Practice Address - Street 1:8700 BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1804
Practice Address - Country:US
Practice Address - Phone:310-423-1447
Practice Address - Fax:310-423-0387
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN265241 NA-07963367500000X
OH265241367500000X
OHCOA.07963.NA367500000X
CA95001655367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2533771Medicaid
IN200508110Medicaid
OH7100040880Medicaid
OH2533771Medicaid