Individual provider · NPI-1

Dr. Gholam Reza Berenji, M.D.

Nuclear Medicine · Los Angeles, CA

NPI number1790809317
StatusActive
Last updated in NPPESJul 8, 2007

Details

NPI
1790809317
Entity type
Individual (NPI-1)
Name
Dr. Gholam Reza Berenji
Credential
M.D.
Sex
Male
Sole proprietor
Yes
Enumeration date
Mar 19, 2007
Last updated
Jul 8, 2007

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207U00000X Nuclear MedicineA96398CAYes

Practice location

11301 Wilshire Blvd
Nuclear Medicine (115)
Los Angeles, CA 90073

Phone 310-268-3583

Mailing address

15 Del Carlo
Irvine, CA 92606-8823

Phone 949-735-3714

Is something wrong?

This page shows exactly what the provider filed with NPPES. Only the provider (or their surrogate) can change it, by signing in to NPPES. Our page updates within a day of their change. See how to update NPI information.

Other Nuclear Medicine providers in Los Angeles, CA