=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861305898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BANDA BERRY HEALTH SERVICES, PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/22/2026
-----------------------------------------------------
Last Update Date | 09/22/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 150 S LOS ROBLES AVE STE 850
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-275-2304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 150 S LOS ROBLES AVE STE 850
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91101-4630
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-275-2304
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | FOUNDER, CEO
-----------------------------------------------------
Name | BENJAMIN BERRY
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-275-2304
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2084P0800X
-----------------------------------------------------
Taxonomy Name | Psychiatry Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------