Healthcare Provider Details

I. General information

NPI: 1295810653
Provider Name (Legal Business Name): ROBERT BEREN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 08/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4821 N STONE AVE
TUCSON AZ
85704-5727
US

IV. Provider business mailing address

12900 PARK PLAZA DR STE 150
CERRITOS CA
90703-9329
US

V. Phone/Fax

Practice location:
  • Phone: 520-409-4299
  • Fax: 520-293-1957
Mailing address:
  • Phone: 562-977-4674
  • Fax: 562-741-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number18791
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: