Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN1001X | Nutrition | DC22592 | CA |
NPI | 1669590535 |
---|---|
Provider Name | Dr. Scott L. Bergman |
First Address | Walnut Creek, CA 94598-2884 |
Second Address | Walnut Creek, CA 94598-2884 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |