Healthcare Provider Details

I. General information

NPI: 1467635367
Provider Name (Legal Business Name): GARY M BERKE MS, CP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 WINWARD WAY SUITE 100
SAN MATEO CA
94404-2499
US

IV. Provider business mailing address

2001 WINWARD WAY SUITE 100
SAN MATEO CA
94404-2499
US

V. Phone/Fax

Practice location:
  • Phone: 650-365-5861
  • Fax: 650-365-5896
Mailing address:
  • Phone: 650-365-5861
  • Fax: 650-365-5896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberCP1628
License Number State
# 3
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberCP1628
License Number State

VIII. Authorized Official

Name: GARY M BERKE
Title or Position: OWNER
Credential: MS, CP
Phone: 650-365-5861