Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | A47762 | CA |
NPI | 1215959077 |
---|---|
Provider Name | Madhu Berman |
First Address | Rancho Palos Verdes, CA 90275 |
Second Address | Rancho Palos Verdes, CA 90275 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 21/05/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F14664 | (02) |