Provider Demographics
NPI:1568573889
Name:BERETTA, SANDRA (MD)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:
Last Name:BERETTA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 N SAN MATEO DR STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-2779
Mailing Address - Country:US
Mailing Address - Phone:650-344-1114
Mailing Address - Fax:650-340-8016
Practice Address - Street 1:136 N SAN MATEO DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-2779
Practice Address - Country:US
Practice Address - Phone:650-344-1114
Practice Address - Fax:650-340-8016
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2017-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG068308207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F36882Medicare UPIN
F36882Medicare UPIN