Active NPI
Rustin Berlow, MD
- Psychiatry Physician
- Del Mar, CA
National Provider Identifier
1164549077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G076945
- Practice address
- 1104 Camino del Mar
Ste 10
Del Mar, CA 92014 - Phone
- (619) 894-4489
- Fax
- (619) 330-1804
- NPI assigned
- Mar 24, 2007
- Reactivated
- Sep 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G76945 | CA | |
| Psychiatry Physician | 2084P0800X | G076945 | CA | Primary |
Addresses
Primary practice location
1104 Camino del Mar
Ste 10
Del Mar, CA 92014
Mailing address
1104 Camino del Mar
Ste 10
Del Mar, CA 92014
Phone (619) 894-4489
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 19, 2020 through Feb 19, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 76945 | CA | MD | Pharmacist |
| G076945 | CA | MD | Psychiatry Physician |
| G76945 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1174694400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1463702400000",
"number": "1164549077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1104 CAMINO DEL MAR",
"address_2": "STE 10",
"city": "DEL MAR",
"state": "CA",
"postal_code": "92014",
"telephone_number": "619-894-4489",
"fax_number": "619-330-1804"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1104 CAMINO DEL MAR",
"address_2": "STE 10",
"city": "DEL MAR",
"state": "CA",
"postal_code": "92014",
"telephone_number": "619-894-4489",
"fax_number": "619-330-1804"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BERLOW",
"first_name": "RUSTIN",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-24",
"last_updated": "2016-05-20",
"deactivation_date": "2007-07-17",
"reactivation_date": "2007-09-19",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G76945",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G076945",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Del Mar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.