Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | POD-663 | CO |
Y | 222Z00000X | Podiatrist | POD-663 | CO |
NPI | 1023230802 |
---|---|
Provider Name | Chrystal Summer Rose Berg |
First Address | Mesa, AZ 85201-3309 |
Second Address | Denver, CO 80204-4507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/05/2007 |
Last Update Date | 29/04/2009 |