Healthcare Provider Details

I. General information

NPI: 1376300970
Provider Name (Legal Business Name): MICHELE BERBERENA PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2024
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11130 MAGNOLIA RD
GRASS VALLEY CA
95949-8366
US

IV. Provider business mailing address

11130 MAGNOLIA RD
GRASS VALLEY CA
95949-8366
US

V. Phone/Fax

Practice location:
  • Phone: 530-268-3700
  • Fax:
Mailing address:
  • Phone: 530-268-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number190119219
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: