Healthcare Provider Details

I. General information

NPI: 1104403955
Provider Name (Legal Business Name): ELYSSA ANN BERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 WESTWOOD PLZ
LOS ANGELES CA
90095-8358
US

IV. Provider business mailing address

757 WESTWOOD PLAZA, INTERNAL MEDICINE
LOS ANGELES CA
90095-4347
US

V. Phone/Fax

Practice location:
  • Phone: 310-825-7375
  • Fax:
Mailing address:
  • Phone: 310-825-7375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA193707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: