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Contact Information

JEFFREY A BERENSON, MD
45081 LITTLE LAKE STREET
MENDOCINO, CA95460
 Phone: 707-937-1055
 Fax: 707-937-1061
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Internal Medicine

207R00000X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for JEFFREY A BERENSON · (Male)

NPI Number 1902828619
Status Active
Credentials MD
Entity Individual
Enumeration date 07/24/2006
Last updated 03/25/2021 - About 5 years ago
Sole proprietor 1 No
Identifiers
  • CA License # G39574
  • CA Medicaid 1902828619
  • CA Other 00G395740 BLUE SHIELD
  • CA Other P00872335 RAILROAD MEDICARE
Hospital affiliation(s)
  • MENDOCINO COAST DISTRICT HOSPITAL - (Critical Access)
    700 RIVER DR
    FORT BRAGG, CA 95437
  • SANTA ROSA MEMORIAL HOSPITAL - (Acute Care)
    1165 MONTGOMERY DR
    SANTA ROSA, CA 95405
  • UKIAH VALLEY MEDICAL CENTER/HOSPITAL D - (Acute Care)
    275 HOSPITAL DRIVE
    UKIAH, CA 95482
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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