Provider Demographics
NPI:1871676056
Name:AUERBACH, DANIEL BERTHOLD (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:BERTHOLD
Last Name:AUERBACH
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 1:15760 VENTURA BLVD
Mailing Address - Street 2:SUITE 1929
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3000
Mailing Address - Country:US
Mailing Address - Phone:818-990-3876
Mailing Address - Fax:818-906-3569
Practice Address - Street 1:15760 VENTURA BLVD
Practice Address - Street 2:SUITE 1929
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3000
Practice Address - Country:US
Practice Address - Phone:818-990-3876
Practice Address - Fax:818-906-3569
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG193922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA90595Medicare UPIN