Provider Demographics
NPI:1215190749
Name:BERDEJA, JESSICA MICHELE (MD)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MICHELE
Last Name:BERDEJA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:YBARRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2500 W UTOPIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85027-4171
Mailing Address - Country:US
Mailing Address - Phone:623-434-6200
Mailing Address - Fax:623-434-6164
Practice Address - Street 1:9225 N 3RD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85020-2439
Practice Address - Country:US
Practice Address - Phone:602-906-3500
Practice Address - Fax:602-906-3519
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2016-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115734207QG0300X
AZ46095207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine