Healthcare Provider Details

I. General information

NPI: 1598742710
Provider Name (Legal Business Name): JASON CHRISTOPHER BERRY D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/10/2025
Certification Date: 07/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

751 S WEIR CANYON RD SUITE 167
ANAHEIM CA
92808-1962
US

IV. Provider business mailing address

751 S WEIR CANYON RD SUITE 167
ANAHEIM CA
92808-1962
US

V. Phone/Fax

Practice location:
  • Phone: 714-974-0611
  • Fax: 714-221-2345
Mailing address:
  • Phone: 714-974-0611
  • Fax: 714-221-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7047
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: