Provider Demographics
NPI:1013002716
Name:BERBANO, MELBA AGATEP (MD)
Entity Type:Individual
Prefix:DR
First Name:MELBA
Middle Name:AGATEP
Last Name:BERBANO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1801 E MARCH LN STE C320
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-6676
Mailing Address - Country:US
Mailing Address - Phone:209-957-5888
Mailing Address - Fax:209-477-9339
Practice Address - Street 1:1801 E MARCH LN STE C320
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-6676
Practice Address - Country:US
Practice Address - Phone:209-957-5888
Practice Address - Fax:209-477-9339
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA053064207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology