Provider Demographics
NPI:1881603074
Name:BERLINER, ROSS ALBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALBERT
Last Name:BERLINER
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 1:3545 GRIFFITH PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1404
Mailing Address - Country:US
Mailing Address - Phone:323-664-4331
Mailing Address - Fax:323-664-4331
Practice Address - Street 1:1417 W BEVERLY BLVD
Practice Address - Street 2:104
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4123
Practice Address - Country:US
Practice Address - Phone:323-721-6026
Practice Address - Fax:323-887-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3948213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E39480Medicaid
CAW12208AOtherMEDICARE ID ARCADIA
CAGRE001100Medicaid
CAGRE000311Medicaid
CAP00171944OtherRAILROAD
CAW10901OtherNARBONNE
CA000E39482Medicaid
CAGR0049330Medicaid
CAWE3948GOtherMEDICARE PIN
CAGRE000310Medicaid
CADA3847OtherRAILROAD
CAP00016205OtherRAILROAD
CAGR0047500Medicaid
CAW11318OtherAVALON
CAW12208OtherMEDICARE ID
CAWE3948FMedicare PIN
CAW12208OtherMEDICARE ID
CAP00016205OtherRAILROAD
CAGRE001100Medicaid
CAGR0047500Medicaid
CA0955160001Medicare NSC