Healthcare Provider Details

I. General information

NPI: 1770535585
Provider Name (Legal Business Name): MARA BEREZNIAK D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11400 PLEASANT VALLEY RD
PENN VALLEY CA
95946-9001
US

IV. Provider business mailing address

13962 LA BARR PINES DR
GRASS VALLEY CA
95949-6317
US

V. Phone/Fax

Practice location:
  • Phone: 530-432-7023
  • Fax: 530-432-7026
Mailing address:
  • Phone: 530-274-7125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A7940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: