MEDICARE: DR. REGINA R. BERKOVICH 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	2084N0400X	Neurology Physician	F5308	CA
2	2084N0400X	Neurology Physician	A105154	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A105154	OTHER	CA	STATE LICENCE

General Provider Information

NPI Number	:	1881743748
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. REGINA R. BERKOVICH MD

Provider Business Mailing Address
First Line	:	8727 BEVERLY BLVD STE B
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1803
Country	:	US
Telephone Number	:	310-474-9595
Fax Number	:

Provider Business Practice Location Address
First Line	:	8727 BEVERLY BLVD STE B
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1803
Country	:	US
Telephone Number	:	310-474-9595
Fax Number	:

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	12/20/2018

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