Healthcare Provider Details

I. General information

NPI: 1720163710
Provider Name (Legal Business Name): AZIZ BERJIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 SEPULVEDA BLVD #209
VAN NUYS CA
91405-4444
US

IV. Provider business mailing address

PO BOX 571163
TARZANA CA
91357-1163
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-5588
  • Fax: 818-986-2481
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4381
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: