Provider Demographics
NPI:1124513981
Name:FIAL, BERKELEY (PA)
Entity type:Individual
Prefix:MISS
First Name:BERKELEY
Middle Name:
Last Name:FIAL
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9635 AVOCET LN
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CO
Mailing Address - Zip Code:80026-9737
Mailing Address - Country:US
Mailing Address - Phone:720-308-1031
Mailing Address - Fax:
Practice Address - Street 1:3575 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-1825
Practice Address - Country:US
Practice Address - Phone:303-449-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-25
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO6557363A00000X
CA55696363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant