Healthcare Provider Details

I. General information

NPI: 1619524428
Provider Name (Legal Business Name): ELIZA BERRIS DDS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 11/07/2020
Certification Date: 11/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19851 YORBA LINDA BLVD STE 201-202
YORBA LINDA CA
92886-2864
US

IV. Provider business mailing address

19851 YORBA LINDA BLVD STE 201-202
YORBA LINDA CA
92886-2864
US

V. Phone/Fax

Practice location:
  • Phone: 714-777-9403
  • Fax:
Mailing address:
  • Phone: 714-777-9403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELIZA BERRIS
Title or Position: OWNER
Credential: DDS
Phone: 714-777-9403