Healthcare Provider Details

I. General information

NPI: 1649358383
Provider Name (Legal Business Name): JANINE W. BERA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 08/12/2020
Certification Date: 08/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 ALHAMBRA BLVD
SACRAMENTO CA
95817
US

IV. Provider business mailing address

777 12TH ST STE 250
SACRAMENTO CA
95814-1929
US

V. Phone/Fax

Practice location:
  • Phone: 916-313-8400
  • Fax: 916-436-5559
Mailing address:
  • Phone: 916-569-8651
  • Fax: 916-447-1780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA74308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: