Individual
PAUL S. BERRY
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1108 WARD AVE, STE A, PATTERSON, CA 95363-8529
(510) 541-8784
(209) 892-9102
Mailing address
216 I ST, A-165, PATTERSON, CA 95363-2301
(510) 541-8784
(209) 892-9102
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
G72073
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G720730
MEDI-CAL
CA
01
—
G72073
STAE LICENSE PHYSICIAN
CA
Enumeration date
10/28/2005
Last updated
03/07/2023
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