Logan, Avis Etta

Logan, Avis Etta is an individual health care provider with primary practice located at 3100 San Pablo Ave # 310 , Berkeley CA 94702. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Logan, Avis Etta can be contacted via phone (510) 985-5020.

Contact Information

Primary practice address
3100 San Pablo Ave # 310 Berkeley CA 94702
Phone: (510) 985-5020
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X G73867 California

Profile Details

NPI number 1235102252
LBN Legal business name Logan, Avis Etta
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Feb 9th, 2006
Last updated Jul 2nd, 2018 - about 7 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1235102252 NPPES
California MEDICAID ZZZ16371Z
California MEDICAID GR0028630

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