Healthcare Provider Details

I. General information

NPI: 1477962504
Provider Name (Legal Business Name): JUDITH BERK MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2014
Last Update Date: 08/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6464 W SUNSET BLVD STE 1040
LOS ANGELES CA
90028-8012
US

IV. Provider business mailing address

15250 VENTURA BLVD STE 710
SHERMAN OAKS CA
91403-3219
US

V. Phone/Fax

Practice location:
  • Phone: 323-836-0900
  • Fax: 323-836-0901
Mailing address:
  • Phone: 818-385-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberG27256
License Number StateCA

VIII. Authorized Official

Name: DR. JUDITH BERK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 323-836-0900