Healthcare Provider Details

I. General information

NPI: 1235969908
Provider Name (Legal Business Name): VALLESKY BERRICH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2024
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1445 SEBASTIAN WAY
SACRAMENTO CA
95864-2736
US

IV. Provider business mailing address

920 COLTON CT
PRINCE FREDERICK MD
20678-4160
US

V. Phone/Fax

Practice location:
  • Phone: 410-474-2495
  • Fax:
Mailing address:
  • Phone: 410-474-2495
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number033628
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: