Healthcare Provider Details

I. General information

NPI: 1184874083
Provider Name (Legal Business Name): CHERISSE DANIELLE BERRY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/26/2008
Last Update Date: 11/04/2022
Certification Date: 11/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD DEPARTMENT OF SURGERY, SUITE 8215
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

8306 WILSHIRE BLVD #844
BEVERLY HILLS CA
90211-2382
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-5874
  • Fax:
Mailing address:
  • Phone: 310-423-5874
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA102693
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number288453
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: