Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | A45608 | CA |
NPI | 1003997032 |
---|---|
Provider Name | Jose Dalio Berganza |
First Address | Baldwin Park, CA 91706-3305 |
Second Address | Baldwin Park, CA 91706-3305 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2006 |
Last Update Date | 08/07/2007 |