MEDICARE: DR. BERUTI I BERUTI MD

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	207V00000X	Obstetrics & Gynecology Physician	35100077B	OH

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104823285
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BERUTI I BERUTI MD

Provider Business Mailing Address
First Line	:	3267 SITIO TORTUGA
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-2007
Country	:	US
Telephone Number	:	760-421-8251
Fax Number	:

Provider Business Practice Location Address
First Line	:	3267 SITIO TORTUGA
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92009-2007
Country	:	US
Telephone Number	:	760-421-8251
Fax Number	:

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

Provider Enumeration Date	:	07/05/2005
Last Update Date	:	01/24/2020

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