Provider Demographics
NPI:1295319994
Name:BERUSCH GERARDINO, ADRIANA SUSANA (NMD)
Entity type:Individual
Prefix:DR
First Name:ADRIANA
Middle Name:SUSANA
Last Name:BERUSCH GERARDINO
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 W 12TH PL
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-5419
Mailing Address - Country:US
Mailing Address - Phone:480-420-4827
Mailing Address - Fax:
Practice Address - Street 1:702 W 12TH PL
Practice Address - Street 2:
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-5419
Practice Address - Country:US
Practice Address - Phone:480-420-4827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-08
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21-1948175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath