Individual
MR. MATTHEW JOSEPH BERRIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
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
363A00000X
Physician Assistant
Primary
PA00573
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1040302
PACIFIC SOURCE
—
05
—
805031400
—
ID
Enumeration date
10/10/2006
Last updated
08/16/2023
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