Basic Information
| Provider Information | |||||||||
| NPI: | 1336694512 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERDUGO | ||||||||
| FirstName: | ANN | ||||||||
| MiddleName: | K | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1828 E CESAR E CHAVEZ AVE STE 5000 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239871200 | ||||||||
| FaxNumber: | 3239871212 | ||||||||
| Practice Location | |||||||||
| Address1: | 1828 E CESAR E CHAVEZ AVE STE 5000 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900332487 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3239871200 | ||||||||
| FaxNumber: | 3239871212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/17/2016 | ||||||||
| LastUpdateDate: | 08/03/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 95004605 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.