Healthcare Provider Details

I. General information

NPI: 1548945652
Provider Name (Legal Business Name): BERREVONNE DAOODI ACSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 06/07/2026
Certification Date: 06/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7227 BROADWAY STE 403
LEMON GROVE CA
91945-1505
US

IV. Provider business mailing address

7227 BROADWAY STE 403
LEMON GROVE CA
91945-1505
US

V. Phone/Fax

Practice location:
  • Phone: 619-771-2181
  • Fax:
Mailing address:
  • Phone: 619-771-2181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133438
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: