Healthcare Provider Details

I. General information

NPI: 1871689471
Provider Name (Legal Business Name): NADEREH SARNEVESHT P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 TELEGRAPH AVE
BERKELEY CA
94705-2063
US

IV. Provider business mailing address

2905 TELEGRAPH AVE
BERKELEY CA
94705-2063
US

V. Phone/Fax

Practice location:
  • Phone: 510-841-0411
  • Fax: 510-845-5030
Mailing address:
  • Phone: 510-841-0411
  • Fax: 510-845-5030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA14477
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: