NPIMap

Organization Active NPI

Cornelia M Pessoa, MD

  • Specialist
  • Berkeley, CA
National Provider Identifier
1760675656
Registry record updated Jan 27, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
G60130 Issued in CA
Legal business name
CORNELIA M PESSOA, MD
Practice address
2500 Milvia St
Suite 104
Berkeley, CA 94704-2636
Phone
(510) 486-1700
Fax
(510) 486-1133
NPI assigned
Aug 23, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Cornelia Moura Pessoa, MDNPI 1689757635
Title
Owner/Physician
Phone
(510) 486-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
SpecialistGroup: 193400000X SINGLE SPECIALTY GROUP 174400000X G60130 CA Primary

Addresses

Primary practice location

2500 Milvia St
Suite 104
Berkeley, CA 94704-2636

Mailing address

2500 Milvia St
Suite 104
Berkeley, CA 94704-2636
Phone (510) 486-1700

Other names 1

  • DERMATOLOGY ASSOCIATES OF BERKELEY Doing business as

National Provider Directory

National Provider Directory

Locations

2500 Milvia St
Ste 104
Berkeley, CA 94704
Phone (510) 486-1700

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187827200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264550400000",
    "number": "1760675656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2500 MILVIA ST",
            "address_2": "SUITE 104",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042636",
            "telephone_number": "510-486-1700",
            "fax_number": "510-486-1133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2500 MILVIA ST",
            "address_2": "SUITE 104",
            "city": "BERKELEY",
            "state": "CA",
            "postal_code": "947042636",
            "telephone_number": "510-486-1700",
            "fax_number": "510-486-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNELIA M PESSOA, MD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-23",
        "last_updated": "2010-01-27",
        "status": "A",
        "authorized_official_last_name": "PESSOA",
        "authorized_official_first_name": "CORNELIA",
        "authorized_official_middle_name": "MOURA",
        "authorized_official_title_or_position": "OWNER/PHYSICIAN",
        "authorized_official_telephone_number": "510-486-1700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "CA",
            "license": "G60130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DERMATOLOGY ASSOCIATES OF BERKELEY",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Berkeley, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.