Healthcare Provider Details

I. General information

NPI: 1508122219
Provider Name (Legal Business Name): NEFTALI NEVAREZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2012
Last Update Date: 08/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST STE 301
BERKELEY CA
94705-2118
US

IV. Provider business mailing address

3687 MT DIABLO BLVD STE 200
LAFAYETTE CA
94549-3746
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-8160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberA119857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: