Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | G60766 | CA |
NPI | 1013076777 |
---|---|
Provider Name | Matthew S. Berry |
First Address | Los Angeles, CA 90034-1702 |
Second Address | Los Angeles, CA 90034-1702 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/12/2006 |
Last Update Date | 18/11/2021 |