Provider Demographics
NPI:1629744248
Name:BERREBI, DANIEL MARK
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:MARK
Last Name:BERREBI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 CLIFTON RD NE FL 3
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30322-4200
Mailing Address - Country:US
Mailing Address - Phone:304-685-1467
Mailing Address - Fax:478-202-9426
Practice Address - Street 1:1525 CLIFTON RD NE FL 3
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30322-4200
Practice Address - Country:US
Practice Address - Phone:304-685-1467
Practice Address - Fax:478-202-9426
Is Sole Proprietor?:No
Enumeration Date:2021-08-23
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program