Provider Demographics
NPI:1306889795
Name:BERMAN, RALPH H (M D)
Entity type:Individual
Prefix:
First Name:RALPH
Middle Name:H
Last Name:BERMAN
Suffix:
Gender:M
Credentials:M D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2687 CHRISTINE OAKS
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-4300
Mailing Address - Country:US
Mailing Address - Phone:831-234-6591
Mailing Address - Fax:831-464-3525
Practice Address - Street 1:412 CEDAR ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4369
Practice Address - Country:US
Practice Address - Phone:831-234-6591
Practice Address - Fax:831-454-3525
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-14
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA224302084P0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22430OtherMEDICAL LICENSE#