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General NPI Number Information
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NPI Number | 1538206875
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Entity Type | Individual
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Provider Name | MELODY ANN JASSEM BERMAN PAC
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Gender | Female
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 04/01/2024
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Provider Practice Location Address
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Address Line | 2425 GEARY BLVD FL 4
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-3358
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Country | US
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Telephone | 415-833-3800
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 SE ROSWELL ST
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City | MILWAUKIE
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State | OR
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Zip | 97222-5069
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Country | US
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Telephone | 415-505-1019
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 60709
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA01235
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA01235
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License Number State | OR
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