Healthcare Provider Details

I. General information

NPI: 1164447900
Provider Name (Legal Business Name): JONATHAN SAMUEL BEREK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 04/19/2024
Certification Date: 04/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 PASTEUR DR
STANFORD CA
94305-2200
US

IV. Provider business mailing address

300 PASTEUR DR
STANFORD CA
94305-2200
US

V. Phone/Fax

Practice location:
  • Phone: 650-723-4000
  • Fax: 650-726-0902
Mailing address:
  • Phone: 650-724-0456
  • Fax: 650-726-0902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG39480
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License NumberG39480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: