Provider Demographics
NPI:1558529065
Name:SANDRA BERETTA, M D, INC
Entity Type:Organization
Organization Name:SANDRA BERETTA, M D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:BERETTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-344-1114
Mailing Address - Street 1:136 N SAN MATEO DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2777
Mailing Address - Country:US
Mailing Address - Phone:650-344-1114
Mailing Address - Fax:650-344-2274
Practice Address - Street 1:136 N SAN MATEO DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2777
Practice Address - Country:US
Practice Address - Phone:650-344-1114
Practice Address - Fax:650-344-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-30
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG068308207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00G683080OtherMEDI-CAL ID
CA00G683080Medicare PIN
CAF36882Medicare UPIN