Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A54336 | CA |
NPI | 1063497691 |
---|---|
Provider Name | Ramin Seyed Berenji |
First Address | San Diego, CA 92123-2684 |
Second Address | El Centro, CA 92243-3623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/12/2005 |
Last Update Date | 18/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A543360 | (05) | CA |
G61412 | (02) | CA |
GL883Y | NO. CALIFORNIA PTAN (01) | CA |
GL883Z | SO. CALIFORNIA PTAN (01) | CA |