Provider Demographics
NPI:1720163710
Name:BERJIS, AZIZ (DPM)
Entity Type:Individual
Prefix:
First Name:AZIZ
Middle Name:
Last Name:BERJIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571163
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1163
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6850 SEPULVEDA BLVD
Practice Address - Street 2:#209
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4444
Practice Address - Country:US
Practice Address - Phone:310-275-5588
Practice Address - Fax:818-986-2481
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4381213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE43810OtherMEDI-CAL
U88819Medicare UPIN
CAE43810OtherMEDI-CAL