Healthcare Provider Details

I. General information

NPI: 1699459008
Provider Name (Legal Business Name): BERKELEY PROFESSIONAL ADVISORS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

177 E COLORADO BLVD STE 200
PASADENA CA
91105-1955
US

IV. Provider business mailing address

PO BOX 778
LA VERNE CA
91750-0778
US

V. Phone/Fax

Practice location:
  • Phone: 909-533-9930
  • Fax:
Mailing address:
  • Phone: 909-533-9930
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: EFFUAH A HARRIS
Title or Position: MANAGING MEMBER
Credential: DMD
Phone: 909-533-9930