Organization
BERKELEY UROLOGICAL ASSOCIATES A MEDICAL GROUP INC. FKA LYON
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA M BETTENCOURT (PRACTICE ADMINISTRATOR)
(510) 848-1733
Entity
Organization
Contact information
Practice address
2999 REGENT ST, #612, BERKELEY, CA 94705-2146
(510) 848-1733
(510) 848-8224
Mailing address
2999 REGENT ST, SUITE 612, BERKELEY, CA 94705-2190
(510) 848-1733
(510) 848-8224
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
YYY49005Y
—
CA
Enumeration date
11/29/2006
Last updated
03/12/2009
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