Provider Demographics
NPI:1881743748
Name:BERKOVICH, REGINA R (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:R
Last Name:BERKOVICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:REGINA
Other - Middle Name:R
Other - Last Name:SALIKHOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8727 BEVERLY BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1803
Mailing Address - Country:US
Mailing Address - Phone:310-474-9595
Mailing Address - Fax:
Practice Address - Street 1:8727 BEVERLY BLVD STE B
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90048-1803
Practice Address - Country:US
Practice Address - Phone:310-474-9595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-09
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF53082084N0400X
CAA1051542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA105154OtherSTATE LICENCE
CAA105154OtherSTATE LICENCE
CAI69271Medicare UPIN