Healthcare Provider Details

I. General information

NPI: 1033240155
Provider Name (Legal Business Name): MINDY ANN WERNER-CROHN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 02/03/2021
Certification Date: 01/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2930 DOMINGO AVE # 218
BERKELEY CA
94705-2454
US

IV. Provider business mailing address

2930 DOMINGO AVE # 218
BERKELEY CA
94705-2454
US

V. Phone/Fax

Practice location:
  • Phone: 818-756-0050
  • Fax: 844-756-0054
Mailing address:
  • Phone: 818-756-0050
  • Fax: 844-756-0054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG53827
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: