Provider Demographics
NPI:1124054440
Name:BERKUS, VICKI LYNN (MD,PHD,CEDS)
Entity type:Individual
Prefix:DR
First Name:VICKI
Middle Name:LYNN
Last Name:BERKUS
Suffix:
Gender:F
Credentials:MD,PHD,CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 ANZA ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4415
Mailing Address - Country:US
Mailing Address - Phone:529-561-5531
Mailing Address - Fax:
Practice Address - Street 1:9 ANZA ST
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4415
Practice Address - Country:US
Practice Address - Phone:529-561-5531
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMTM2016-07882084P0800X
AZ202602084P0800X
CODR.00497822084P0800X
FLME1064032084P0800X
OK350832084P0800X
MN664532084P0800X
CAG-1450962084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ73509Medicare UPIN