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General NPI Number Information
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NPI Number | 1104033901
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Entity Type | Organization
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Legal Business Name | JILL R. BERLIN, DPM INC
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 26912 CARRANZA DR
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City | MISSION VIEJO
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State | CA
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Zip | 92691-5002
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Country | US
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Telephone | 949-581-2944
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Fax | 949-768-2647
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Provider Business Mailing Address
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Address Line | PO BOX 146
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City | LAKE FOREST
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State | CA
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Zip | 92609-0146
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Country | US
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Telephone | 949-581-2944
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Fax | 949-768-2647
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Authorized Official
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Title or Position | CEO,PRESIDENT
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Name | DR. JILL ROBIN BERLIN
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Credential | DPM
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Telephone | 949-581-2944
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | E3871
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License Number State | CA
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