Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 46095 | AZ |
N | 207QG0300X | Family Doctor - Geriatric Medicine | A115734 | CA |
NPI | 1215190749 |
---|---|
Provider Name | Jessica Michele Berdeja |
First Address | Phoenix, AZ 85027-4171 |
Second Address | Phoenix, AZ 85020-2439 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/07/2008 |
Last Update Date | 11/01/2016 |