Healthcare Provider Details

I. General information

NPI: 1215959077
Provider Name (Legal Business Name): MADHU BERMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MADHU NAIDU M.D.

II. Dates (important events)

Enumeration Date: 07/24/2006
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29000 WESTERN AVE STE #200
RANCHO PALOS VERDES CA
90275
US

IV. Provider business mailing address

29000 WESTERN AVE STE NO 200
RANCHO PALOS VERDES CA
90275
US

V. Phone/Fax

Practice location:
  • Phone: 310-833-1334
  • Fax: 310-833-0270
Mailing address:
  • Phone: 310-833-1334
  • Fax: 310-833-0270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License NumberA47762
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: