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General NPI Number Information
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NPI Number | 1902092380
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Entity Type | Individual
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Provider Name | MARLENE CAMILLE BERANEK RNC, MN, NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/19/2007
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Last Update Date | 08/05/2011
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Provider Practice Location Address
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Address Line | 1000 W CARSON ST
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City | TORRANCE
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State | CA
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Zip | 90502-2004
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Country | US
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Telephone | 310-222-2314
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Fax |
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Provider Business Mailing Address
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Address Line | 5806 OCEAN TERRACE DR
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275-5759
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Country | US
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Telephone | 310-377-5074
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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 | 363LN0005X
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Taxonomy Name | Critical Care Neonatal Nurse Practitioner
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License Number | 414878
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License Number State | CA
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