MEDICARE: JULIA FAY 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
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1780202473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA FAY BERMAN

Provider Business Mailing Address
First Line	:	4016 VIA PIMA
Second Line	:
City	:	PALOS VERDES ESTATES
State	:	CA
Zip	:	90274-1460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2923 BRADLEY ST STE 120
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91107-1503
Country	:	US
Telephone Number	:	626-795-6596
Fax Number	:

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

Provider Enumeration Date	:	07/08/2020
Last Update Date	:	07/21/2020

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Directions to “ JULIA FAY BERMAN ” Practice Location

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