Healthcare Provider Details

I. General information

NPI: 1962835876
Provider Name (Legal Business Name): SARA ELIZABETH BERDY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 POTRERO AVE
SAN FRANCISCO CA
94110
US

IV. Provider business mailing address

1001 POTRERO AVE STE 3A
SAN FRANCISCO CA
94110-3518
US

V. Phone/Fax

Practice location:
  • Phone: 415-206-2557
  • Fax: 415-206-5153
Mailing address:
  • Phone: 415-206-2557
  • Fax: 415-206-5153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number768833
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number23342
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: