Provider Demographics
NPI:1578720751
Name:CEDARS, PHYLLIS IRENE (MD)
Entity Type:Individual
Prefix:DR
First Name:PHYLLIS
Middle Name:IRENE
Last Name:CEDARS
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 1:2920 DOMINGO AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2400
Mailing Address - Country:US
Mailing Address - Phone:510-466-5636
Mailing Address - Fax:
Practice Address - Street 1:2920 DOMINGO AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2400
Practice Address - Country:US
Practice Address - Phone:510-466-5636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG457122084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry