Healthcare Provider Details

I. General information

NPI: 1013068931
Provider Name (Legal Business Name): MYRON TZALEL BERDISCHEWSKY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12215 VENTURA BLVD SUITE 106
STUDIO CITY CA
91604-2533
US

IV. Provider business mailing address

14301 MILLBROOK DR
SHERMAN OAKS CA
91423-4426
US

V. Phone/Fax

Practice location:
  • Phone: 818-769-2247
  • Fax:
Mailing address:
  • Phone: 818-907-6103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License NumberG34045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: