Provider Demographics
NPI:1366553885
Name:BERJIS, FARAZ (MD)
Entity type:Individual
Prefix:DR
First Name:FARAZ
Middle Name:
Last Name:BERJIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2999 REGENT ST
Mailing Address - Street 2:SUITE 425
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2146
Mailing Address - Country:US
Mailing Address - Phone:510-548-6555
Mailing Address - Fax:510-548-0176
Practice Address - Street 1:2999 REGENT ST
Practice Address - Street 2:SUITE 425
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2146
Practice Address - Country:US
Practice Address - Phone:510-548-6555
Practice Address - Fax:510-548-0176
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA73092174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A730921Medicare PIN
GAG92096Medicare UPIN