Provider Demographics
NPI:1528107026
Name:CITY OF BERKELEY PUBLIC HEALTH CLINIC (TB-IZ)
Entity type:Organization
Organization Name:CITY OF BERKELEY PUBLIC HEALTH CLINIC (TB-IZ)
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:BERREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:510-981-5301
Mailing Address - Street 1:830 UNIVERSITY AVE.
Mailing Address - Street 2:PUBLIC HEALTH CLINIC
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94710
Mailing Address - Country:US
Mailing Address - Phone:510-981-5399
Mailing Address - Fax:510-981-5385
Practice Address - Street 1:830 UNIVERSITY AVE.
Practice Address - Street 2:PUBLIC HEALTH CLINIC
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94710
Practice Address - Country:US
Practice Address - Phone:510-981-5399
Practice Address - Fax:510-981-5385
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF BERKELEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-05
Last Update Date:2013-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZR11877FMedicaid