Healthcare Provider Details

I. General information

NPI: 1336158328
Provider Name (Legal Business Name): TERRI D PAGANO P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 WEBSTER ST SUITE 300
BERKELEY CA
94705-2557
US

IV. Provider business mailing address

2510 WEBSTER ST SUITE 300
BERKELEY CA
94705-2557
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-8700
  • Fax: 510-295-2651
Mailing address:
  • Phone: 510-841-8700
  • Fax: 510-295-2651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18304
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA18304
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18304
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: