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Individual

MISS BERKELEY FIAL

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA

Contact information

Practice address
3575 BROADWAY ST, BOULDER, CO 80304-1825
(303) 449-0933
Mailing address
9635 AVOCET LN, LAFAYETTE, CO 80026-9737
(720) 308-1031

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
55696
CA
363A00000X
Physician Assistant
Primary
6557
CO

Other

Enumeration date
06/25/2018
Last updated
09/01/2021
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