Provider Demographics
NPI:1700230224
Name:BERBERYAN, ANI (MD)
Entity Type:Individual
Prefix:
First Name:ANI
Middle Name:
Last Name:BERBERYAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9140 HAVEN AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-5414
Mailing Address - Country:US
Mailing Address - Phone:909-296-7800
Mailing Address - Fax:909-509-5511
Practice Address - Street 1:9140 HAVEN AVE STE 112
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-5414
Practice Address - Country:US
Practice Address - Phone:909-296-7800
Practice Address - Fax:909-509-5511
Is Sole Proprietor?:No
Enumeration Date:2016-04-21
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA160957207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine