Provider Demographics
NPI:1336438597
Name:BERNER, JAMIE
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:
Last Name:BERNER
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:COUGHLAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ND
Mailing Address - Street 1:120 LA CASA VIA STE 104
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3094
Mailing Address - Country:US
Mailing Address - Phone:925-939-0300
Mailing Address - Fax:925-939-3181
Practice Address - Street 1:120 LA CASA VIA STE 104
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3094
Practice Address - Country:US
Practice Address - Phone:925-939-0300
Practice Address - Fax:925-939-3181
Is Sole Proprietor?:No
Enumeration Date:2011-03-28
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAND-448175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath