Organization
STEPHEN C BERENS, MD A MED. CORP.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. ROBERTA J BERENS M.D. (VICE PRE & SEC. OF CORPORATION)
(310) 828-4633
Entity
Organization
Contact information
Practice address
1301 20TH ST., SUITE 590, SANTA MONICA, CA 90404
(310) 828-4633
(818) 784-5639
Mailing address
POB 261037, SUITE 268W, ENCINO, CA 91426-1037
(310) 828-4633
(310) 828-6205
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
A22556
CA
207RC0000X
Cardiovascular Disease Physician
Primary
A-22556
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1528050408
PERSONAL NATIONAL PROVIDE
CA
Enumeration date
01/24/2007
Last updated
06/10/2011
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