Basic Information
| Provider Information | |||||||||
| NPI: | 1063497691 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERENJI | ||||||||
| FirstName: | RAMIN | ||||||||
| MiddleName: | SEYED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9610 GRANITE RIDGE DR | ||||||||
| Address2: | STE B | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921232684 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8588108000 | ||||||||
| FaxNumber: | 8582681911 | ||||||||
| Practice Location | |||||||||
| Address1: | 2205 ROSS AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | EL CENTRO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 922433623 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7603530404 | ||||||||
| FaxNumber: | 7603530392 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 09/18/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | A54336 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 00A543360 | 05 | CA | MEDICAID | GL883Z | 01 | CA | SO. CALIFORNIA PTAN | OTHER | GL883Y | 01 | CA | NO. CALIFORNIA PTAN | OTHER |