Healthcare Provider Details

I. General information

NPI: 1013230440
Provider Name (Legal Business Name): MIRIAM MONA GAFFER FERREIRA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2010
Last Update Date: 03/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2828 TELEGRAPH AVE
BERKELEY CA
94705-1119
US

IV. Provider business mailing address

28094 PETRINA CT
HAYWARD CA
94545-4968
US

V. Phone/Fax

Practice location:
  • Phone: 510-848-8404
  • Fax: 510-848-6312
Mailing address:
  • Phone: 510-783-5978
  • Fax: 510-783-5978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: