Healthcare Provider Details

I. General information

NPI: 1851409924
Provider Name (Legal Business Name): MELBA A. BERBANO MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E MARCH LN STE C320
STOCKTON CA
95210-6676
US

IV. Provider business mailing address

1801 E MARCH LN STE C320
STOCKTON CA
95210-6676
US

V. Phone/Fax

Practice location:
  • Phone: 209-957-5888
  • Fax: 209-477-9339
Mailing address:
  • Phone: 209-957-5888
  • Fax: 209-477-9339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MELBA BERBANO
Title or Position: OBSTETRICIAN/GYNECOLOGIST
Credential: MD
Phone: 209-957-5888