MEDICARE: AVIS ETTA LOGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G73867	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235102252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AVIS ETTA LOGAN MD

Provider Business Mailing Address
First Line	:	1450 TREAT BLVD # 300
Second Line	:
City	:	WALNUT CREEK
State	:	CA
Zip	:	94597-2168
Country	:	US
Telephone Number	:	925-952-2888
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 SAN PABLO AVE # 310
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94702
Country	:	US
Telephone Number	:	510-985-5020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2006
Last Update Date	:	07/02/2018

Similar Medicare Providers

1366445470 — NATALIE MARSHALL M.D.
Practice Location Address:

3100 SAN PABLO AVE. , SUITE 430
BERKELEY, CA
94702

Practice Phone: 510-420-8000
Practice Fax: 510-985-5202

1689670002 — LIFELONG MEDICAL CARE
Practice Location Address:

3260 SACRAMENTO ST
BERKELEY, CA
94702-2739

Practice Phone: 510-428-4500
Practice Fax:

1033101118 — AUDREY DANDREA MD
Practice Location Address:

3100 SAN PABLO AVE # 310
BERKELEY, CA
94702

Practice Phone: 925-985-5020
Practice Fax:

1659366771 — CHAPARRAL FOUNDATION
Practice Location Address:

1309 ALLSTON WAY
BERKELEY, CA
94702-1920

Practice Phone: 510-848-8774
Practice Fax: 510-848-2438

1811985823 — MR. SANDY STEINMAN L.C.S.W.
Practice Location Address:

1429 ACTON ST
BERKELEY, CA
94702-1238

Practice Phone: 510-526-9699
Practice Fax:

1225009319 — MS. MELISSA BARBARA ALLEN NP
Practice Location Address:

3260 SACRAMENTO ST
BERKELEY, CA
94702-2739

Practice Phone: 510-601-6060
Practice Fax: 510-553-2166

Directions to “ AVIS ETTA LOGAN MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.