| Sophia N. Mirviss, M.d., Inc. | |
|
3000 Colby St Ste 201 Berkeley CA 94705-2058 | |
| (510) 843-0692 | |
| Not Available |
| Full Name | Sophia N. Mirviss, M.d., Inc. |
|---|---|
| Speciality | Clinic/Center |
| Location | 3000 Colby St Ste 201, Berkeley, California |
| Authorized Official Name and Position | Laurie Ervin (BILLING MANAGER) |
| Authorized Official Contact | 9252869039 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sophia N. Mirviss, M.d., Inc. 3000 Colby St Ste 201 Berkeley CA 94705-2058 Ph: (510) 843-0692 | Sophia N. Mirviss, M.d., Inc. 3000 Colby St Ste 201 Berkeley CA 94705-2058 Ph: (510) 843-0692 |
| NPI Number | 1285265769 |
|---|---|
| Provider Enumeration Date | 02/03/2020 |
| Last Update Date | 02/03/2020 |
| Medicare PECOS PAC ID | 9830528173 |
|---|---|
| Medicare Enrollment ID | O20200407002977 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285265769 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
| Provider Name | Sophia N Mirviss |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1295874956 PECOS PAC ID: 4587751789 Enrollment ID: I20090110000090 |
| Provider Name | Tenzin Ngadon |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1912324757 PECOS PAC ID: 5193047918 Enrollment ID: I20141206000010 |
| Provider Name | Thomas J Cutillo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1225201353 PECOS PAC ID: 5991006256 Enrollment ID: I20151211000302 |
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