Healthcare Provider Details

I. General information

NPI: 1003930041
Provider Name (Legal Business Name): GEMMA BERDIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 N 4TH ST SUITE 100
SAN JOSE CA
95112-5569
US

IV. Provider business mailing address

1324 S WINCHESTER BLVD # 66
SAN JOSE CA
95128-4341
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-5288
  • Fax: 408-292-1029
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN 221203
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: