Individual
MARY A MIOUX BERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
630 S RAYMOND AVE, SUITE #120, PASADENA, CA 91105-3278
(626) 403-1444
(626) 403-1448
Mailing address
630 S RAYMOND AVE, SUITE #120, PASADENA, CA 91105-3278
(626) 403-1444
(626) 403-1448
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
036084547
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
20A8359
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0006005217
BLUE CROSS BLUE SHIELD
IL
01
—
250004104
RAILROAD MEDICAID
IL
Enumeration date
06/27/2005
Last updated
10/08/2009
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