Provider Demographics
NPI:1841757598
Name:BEBERO, MA MILDRED (FNP)
Entity Type:Individual
Prefix:
First Name:MA MILDRED
Middle Name:
Last Name:BEBERO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:MILDRED
Other - Middle Name:
Other - Last Name:BEBERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:410 E YOSEMITE AVE
Mailing Address - Street 2:STE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8220
Mailing Address - Country:US
Mailing Address - Phone:209-384-9108
Mailing Address - Fax:
Practice Address - Street 1:315 E 13TH ST
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6211
Practice Address - Country:US
Practice Address - Phone:209-564-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95010918363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care