Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | PA18518 | CA |
NPI | 1053468298 |
---|---|
Provider Name | Mr. Arnie Perea Bergula |
First Address | Poway, CA 92064-2635 |
Second Address | Los Alamitos, CA 90720-3108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/01/2007 |
Last Update Date | 01/12/2021 |