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General NPI Number Information
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NPI Number | 1891991014
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Entity Type | Individual
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Provider Name | JACQUELINE KIRSTIE BERRY MD
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 621 N SAN VICENTE BLVD
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-5018
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Country | US
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Telephone | 323-358-2423
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 19067
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City | LONG BEACH
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State | CA
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Zip | 90807-9067
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Country | US
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Telephone | 562-981-0425
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A060134
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License Number State | CA
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