Healthcare Provider Details

I. General information

NPI: 1689643884
Provider Name (Legal Business Name): ROBERTA L BERG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/17/2006
Last Update Date: 10/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

144 STONY POINT ROAD SONOMA COUNTY INDIAN HEALTH PROJECT
SANTA ROSA CA
95401
US

IV. Provider business mailing address

144 STONY POINT ROAD SONOMA COUNTY INDIAN HEALTH PROJECT
SANTA ROSA CA
95401
US

V. Phone/Fax

Practice location:
  • Phone: 707-521-4500
  • Fax: 707-544-4626
Mailing address:
  • Phone: 707-521-4500
  • Fax: 707-544-4626

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG18770
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: