Healthcare Provider Details

I. General information

NPI: 1538206875
Provider Name (Legal Business Name): MELODY ANN JASSEM BERMAN PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2425 GEARY BLVD FL 4
SAN FRANCISCO CA
94115-3358
US

IV. Provider business mailing address

4505 SE ROSWELL ST
MILWAUKIE OR
97222-5069
US

V. Phone/Fax

Practice location:
  • Phone: 415-833-3800
  • Fax:
Mailing address:
  • Phone: 415-505-1019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number60709
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA01235
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA01235
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: