MEDICARE: DR. JASON A BERKLEY D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician	20A8006	CA

General Provider Information

NPI Number	:	1033119250
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JASON A BERKLEY D.O.

Provider Business Mailing Address
First Line	:	122 SHELDON ST
Second Line	:
City	:	EL SEGUNDO
State	:	CA
Zip	:	90245-3915
Country	:	US
Telephone Number	:	310-322-4278
Fax Number	:	310-322-6660

Provider Business Practice Location Address
First Line	:	444 S SAN VICENTE BLVD
Second Line	:	800
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4165
Country	:	US
Telephone Number	:	310-423-9900
Fax Number	:	310-423-9965

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	09/23/2013

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