Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | 16262 | CA |
NPI | 1528058559 |
---|---|
Provider Name | Dr. Fred S Berman |
First Address | Fresno, CA 93726-0904 |
Second Address | Fresno, CA 93726-0904 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 08/07/2007 |