| Berkeley Family Practice Medical Group | |
|
2636 Telegraph Ave Berkeley CA 94704-3322 | |
| (510) 841-1647 | |
| (510) 848-4924 |
| Full Name | Berkeley Family Practice Medical Group |
|---|---|
| Speciality | Family Medicine |
| Location | 2636 Telegraph Ave, Berkeley, California |
| Authorized Official Name and Position | Loren Palacios (ADMINISTRATOR) |
| Authorized Official Contact | 5108411647 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Berkeley Family Practice Medical Group 2636 Telegraph Ave Ste A Berkeley CA 94704-3373 Ph: (510) 841-1647 | Berkeley Family Practice Medical Group 2636 Telegraph Ave Berkeley CA 94704-3322 Ph: (510) 841-1647 |
| NPI Number | 1821104100 |
|---|---|
| Provider Enumeration Date | 08/21/2006 |
| Last Update Date | 12/06/2023 |
| Medicare PECOS PAC ID | 4385704576 |
|---|---|
| Medicare Enrollment ID | O20081118000329 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1821104100 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (California) | Primary |
| Provider Name | Julie Goo |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1003872961 PECOS PAC ID: 5092761908 Enrollment ID: I20050323001323 |
| Provider Name | Timothy A Fitzer |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801852686 PECOS PAC ID: 1254491442 Enrollment ID: I20081229000012 |
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