Provider Demographics
NPI:1730193491
Name:BERMAN, ROBIN LYNN (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LYNN
Last Name:BERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LYNN
Other - Last Name:ROSENBLATE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11828 LA GRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-826-4321
Mailing Address - Fax:310-826-3539
Practice Address - Street 1:12011 SAN VINCENTE BLVD.
Practice Address - Street 2:SUITE 250C
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049
Practice Address - Country:US
Practice Address - Phone:310-826-4321
Practice Address - Fax:310-826-3539
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2021-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA834592084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A834590OtherMEDI CAL
CA00A834590OtherBLUE SHIELD
CA00A834590OtherBLUE SHIELD
CAG89393Medicare UPIN