Healthcare Provider Details

I. General information

NPI: 1306889795
Provider Name (Legal Business Name): RALPH H. BERMAN M D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 02/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 CEDAR ST SUITE A
SANTA CRUZ CA
95060-4369
US

IV. Provider business mailing address

2687 CHRISTINE OAKS
SANTA CRUZ CA
95062-4300
US

V. Phone/Fax

Practice location:
  • Phone: 831-234-6591
  • Fax: 831-454-3525
Mailing address:
  • Phone: 831-234-6591
  • Fax: 831-464-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA22430
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA22430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: