Healthcare Provider Details

I. General information

NPI: 1104175611
Provider Name (Legal Business Name): JANEECE A BERRY RNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2012
Last Update Date: 08/02/2022
Certification Date: 07/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BEVERLY CARE 1920 W. WHITTIER BLVD
MONTEBELLO CA
90640
US

IV. Provider business mailing address

2839 PARK SQUARE WAY
POMONA CA
91767
US

V. Phone/Fax

Practice location:
  • Phone: 323-725-1519
  • Fax:
Mailing address:
  • Phone: 909-331-7617
  • Fax: 909-447-0968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number8348
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number375301
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: