Provider Demographics
NPI:1386121093
Name:CHRISTOPHER BERLIOZ DO PA
Entity type:Organization
Organization Name:CHRISTOPHER BERLIOZ DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:KAFATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-763-6335
Mailing Address - Street 1:810 FENWICK DR
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-2877
Mailing Address - Country:US
Mailing Address - Phone:956-763-6335
Mailing Address - Fax:
Practice Address - Street 1:10710 MCPHERSON RD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6363
Practice Address - Country:US
Practice Address - Phone:956-724-4822
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-25
Last Update Date:2018-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR6975208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty