Healthcare Provider Details

I. General information

NPI: 1093998122
Provider Name (Legal Business Name): BEVERLY RADIOLOGY MEDICAL GROUP III
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2007
Last Update Date: 04/03/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 210
PASADENA CA
91105-3283
US

IV. Provider business mailing address

PO BOX 101418
PASADENA CA
91189-0025
US

V. Phone/Fax

Practice location:
  • Phone: 818-616-6538
  • Fax: 818-342-0303
Mailing address:
  • Phone: 844-866-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HOWARD G. BERGER
Title or Position: PRESIDENT / CEO
Credential: M.D
Phone: 310-445-2800