Provider Demographics
NPI:1871806711
Name:NATALIE KARISHEV MD PROFESSIONAL
Entity type:Organization
Organization Name:NATALIE KARISHEV MD PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KARISHEV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-845-2422
Mailing Address - Street 1:3021 DANA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2073
Mailing Address - Country:US
Mailing Address - Phone:510-845-2422
Mailing Address - Fax:510-845-7802
Practice Address - Street 1:3021 DANA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2073
Practice Address - Country:US
Practice Address - Phone:510-845-2422
Practice Address - Fax:510-845-7802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2015-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA 105280261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care