Healthcare Provider Details

I. General information

NPI: 1285302612
Provider Name (Legal Business Name): MARK RESCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2021
Last Update Date: 08/31/2021
Certification Date: 08/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2712 TELEGRAPH AVE
BERKELEY CA
94705-1117
US

IV. Provider business mailing address

6425 CENTRAL AVE APT 201
EL CERRITO CA
94530-3540
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax: 510-548-2938
Mailing address:
  • Phone: 408-230-3610
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: