Provider Demographics
NPI:1699459008
Name:BERKELEY PROFESSIONAL ADVISORS, LLC
Entity type:Organization
Organization Name:BERKELEY PROFESSIONAL ADVISORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:EFFUAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:909-533-9930
Mailing Address - Street 1:PO BOX 778
Mailing Address - Street 2:
Mailing Address - City:LA VERNE
Mailing Address - State:CA
Mailing Address - Zip Code:91750-0778
Mailing Address - Country:US
Mailing Address - Phone:909-533-9930
Mailing Address - Fax:
Practice Address - Street 1:177 E COLORADO BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1955
Practice Address - Country:US
Practice Address - Phone:909-533-9930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Multi-Specialty