Healthcare Provider Details

I. General information

NPI: 1417236225
Provider Name (Legal Business Name): BURTON BEREZ CRT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2011
Last Update Date: 08/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 N TOWN CENTER DR #120
LAS VEGAS NV
89144-6301
US

IV. Provider business mailing address

101 LUNA WAY #155
LAS VEGAS NV
89145-0171
US

V. Phone/Fax

Practice location:
  • Phone: 818-935-3727
  • Fax: 866-960-7692
Mailing address:
  • Phone: 702-438-2729
  • Fax: 702-795-2729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRC 1189
License Number StateNV
# 2
Primary TaxonomyN
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberTT 3919
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: