Healthcare Provider Details

I. General information

NPI: 1932247251
Provider Name (Legal Business Name): AMERISH BABULAL BERA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 01/07/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD
SACRAMENTO CA
95817-2201
US

IV. Provider business mailing address

6107 PIRATE POINT CT
ELK GROVE CA
95758-4214
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-4101
  • Fax: 916-734-4104
Mailing address:
  • Phone: 916-734-4101
  • Fax: 916-734-4104

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberG070645
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: