Provider Demographics
NPI:1366027823
Name:BERKLEY, BONNIE (MPH)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:
Last Name:BERKLEY
Suffix:
Gender:F
Credentials:MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 MATAGORDA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78210-1018
Mailing Address - Country:US
Mailing Address - Phone:210-533-8886
Mailing Address - Fax:
Practice Address - Street 1:1302 S SAINT MARYS ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78210-1226
Practice Address - Country:US
Practice Address - Phone:210-533-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174H00000XOther Service ProvidersHealth Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
9214367921OtherN/A