Basic Information
| Provider Information | |||||||||
| NPI: | 1508193640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERHANE | ||||||||
| FirstName: | AMAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 SAN GABRIEL BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | ROSEMEAD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917704394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3237240019 | ||||||||
| FaxNumber: | 3232487044 | ||||||||
| Practice Location | |||||||||
| Address1: | 4126 MAINE AVE | ||||||||
| Address2: | |||||||||
| City: | BALDWIN PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917063306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5628678681 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/10/2009 | ||||||||
| LastUpdateDate: | 11/15/2019 | ||||||||
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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 | 363A00000X | PA 20619 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.