Provider Demographics
NPI:1518223080
Name:JANIK, REBECCA SORENSON (MD)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SORENSON
Last Name:JANIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 COLBY ST
Mailing Address - Street 2:SUITE 114
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2091
Mailing Address - Country:US
Mailing Address - Phone:510-848-1413
Mailing Address - Fax:
Practice Address - Street 1:3010 COLBY ST
Practice Address - Street 2:SUITE 114
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2091
Practice Address - Country:US
Practice Address - Phone:510-848-1413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-09
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA142246207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology