=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013647627
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALEPH MEDICAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/15/2022
-----------------------------------------------------
Last Update Date | 06/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13273 FIJI WAY #315
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-7093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-739-8309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 13273 FIJI WAY STE 315
-----------------------------------------------------
City | MARINA DEL REY
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90292-7093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-739-8309
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PROVIDER
-----------------------------------------------------
Name | DR. ANTHONY A BERTRAND
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 310-739-8309
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2086S0122X
-----------------------------------------------------
Taxonomy Name | Plastic and Reconstructive Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------