Healthcare Provider Details

I. General information

NPI: 1275619330
Provider Name (Legal Business Name): BERKELEY UROLOGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT STREET SUITE 612
BERKELEY CA
94705
US

IV. Provider business mailing address

2999 REGENT STREET SUITE 612
BERKELEY CA
94705
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-1727
  • Fax:
Mailing address:
  • Phone: 510-848-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA43674
License Number StateCA

VIII. Authorized Official

Name: JOEL ABRAHM PISER III
Title or Position: UROLOGIST
Credential: M.D
Phone: 510-848-1727