Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC14314 | CA |
NPI | 1386785483 |
---|---|
Provider Name | Dr. Linda Berry |
First Address | San Rafael, CA 94901-3857 |
Second Address | Albany, CA 94706-2059 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/02/2007 |
Last Update Date | 16/05/2014 |