Provider Demographics
NPI:1205869286
Name:BERBERICH, FELIX RALPH (MD)
Entity type:Individual
Prefix:
First Name:FELIX
Middle Name:RALPH
Last Name:BERBERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:F
Other - Middle Name:RALPH
Other - Last Name:BERBERICH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2500 MILVIA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-2636
Mailing Address - Country:US
Mailing Address - Phone:510-204-5600
Mailing Address - Fax:510-204-5462
Practice Address - Street 1:2500 MILVIA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-2636
Practice Address - Country:US
Practice Address - Phone:510-204-5600
Practice Address - Fax:510-204-5462
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2018-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG-17754208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G177540Medicaid
CA000G177540OtherB.S.