Healthcare Provider Details

I. General information

NPI: 1720493661
Provider Name (Legal Business Name): ALIA MARIE BERLIN F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2014
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

PO BOX 3517
SAN RAFAEL CA
94912-3517
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-7154
  • Fax: 415-925-7652
Mailing address:
  • Phone: 415-457-8182
  • Fax: 415-457-3490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95000806
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: