Provider Demographics
NPI:1740377118
Name:BERNA, ZOE D (MD)
Entity type:Individual
Prefix:
First Name:ZOE
Middle Name:D
Last Name:BERNA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 RIVER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:FORT BRAGG
Mailing Address - State:CA
Mailing Address - Zip Code:95437-5403
Mailing Address - Country:US
Mailing Address - Phone:707-961-4631
Mailing Address - Fax:707-964-1192
Practice Address - Street 1:721 RIVER DR
Practice Address - Street 2:SUITE A
Practice Address - City:FORT BRAGG
Practice Address - State:CA
Practice Address - Zip Code:95437-5403
Practice Address - Country:US
Practice Address - Phone:707-961-4631
Practice Address - Fax:707-964-1192
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA80888207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A808880Medicaid
CAAN309TMedicare PIN
CAAN309SMedicare PIN
CAAN309XMedicare PIN
00A808880Medicare ID - Type Unspecified
CA00A808880Medicaid