Healthcare Provider Details

I. General information

NPI: 1750483616
Provider Name (Legal Business Name): UNIVERSITY HEAD AND NECK ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 06/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 MEDICAL PLAZA 550
LOS ANGELES CA
90095
US

IV. Provider business mailing address

PO BOX 512025 DEPT A20
LOS ANGELES CA
90051
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6688
  • Fax: 310-206-1393
Mailing address:
  • Phone: 310-206-6688
  • Fax: 310-206-1393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207YX0901X
TaxonomyOtology & Neurotology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GERALD S BERKE
Title or Position: PROF CHIEF HEAD AND NECK UCLA
Credential:
Phone: 310-825-5179