MEDICARE: JUDITH MONDRY - BERK M D

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	2084P0800X	Psychiatry Physician	G27256	CA

General Provider Information

NPI Number	:	1285826123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUDITH MONDRY - BERK M D

Provider Business Mailing Address
First Line	:	6464 W SUNSET BLVD
Second Line	:	SUITE 1040
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-8001
Country	:	US
Telephone Number	:	323-836-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	6464 W SUNSET BLVD
Second Line	:	SUITE 1040
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-8001
Country	:	US
Telephone Number	:	323-836-0900
Fax Number	:

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

Provider Enumeration Date	:	08/14/2007
Last Update Date	:	05/14/2008

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