Organization
SNAKE RIVER PEDIATRICS, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MATTHEW JOSEPH BERRIA PHD, PA-C (PRESIDENT)
(208) 740-4518
Entity
Organization
Contact information
Practice address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
(541) 216-6557
Mailing address
1100 NW 12TH ST, FRUITLAND, ID 83619-5040
(208) 452-6556
(541) 216-6557
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
OR
363A00000X
Physician Assistant
—
OR
363LP0200X
Pediatric Nurse Practitioner
—
OR
Other
Enumeration date
02/15/2016
Last updated
02/01/2024
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