Provider Demographics
NPI:1215648225
Name:BEREN, VIRYNA S (PA-C)
Entity type:Individual
Prefix:
First Name:VIRYNA
Middle Name:S
Last Name:BEREN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:VIRYNA
Other - Middle Name:
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3645 S ROME ST
Mailing Address - Street 2:STE 201
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85297
Mailing Address - Country:US
Mailing Address - Phone:928-266-5761
Mailing Address - Fax:480-443-8697
Practice Address - Street 1:3645 S ROME ST
Practice Address - Street 2:STE 201
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297
Practice Address - Country:US
Practice Address - Phone:480-443-8400
Practice Address - Fax:480-443-8697
Is Sole Proprietor?:No
Enumeration Date:2022-12-09
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
AZ1210957363A00000X
AZ10965363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program