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NPI Code Detail

MEDICARE: RALPH BERMAN

MEDICARE: RALPH BERMAN
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
1101YA0400XAddiction (Substance Use Disorder) CounselorB0809051024CA
2101YA0400XAddiction (Substance Use Disorder) Counselor1711135CA

General Provider Information

NPI Number : 1730454307
Entity Type Code : Individual
Provider Name (Legal Business Name) : RALPH BERMAN
Provider Business Mailing Address
First Line : 590 W. 8TH STREET
Second Line :
City : SAN PEDRO
State : CA
Zip : 90731
Country : US
Telephone Number : 310-831-2358
Fax Number : 310-831-2356
Provider Business Practice Location Address
First Line : 505 S PACIFIC AVE
Second Line : SUITE 205
City : SAN PEDRO
State : CA
Zip : 90731-2656
Country : US
Telephone Number : 310-831-2358
Fax Number : 310-831-2356
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/15/2012
Last Update Date : 06/13/2017

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Directions to “ RALPH BERMAN ” Practice Location

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