Healthcare Provider Details

I. General information

NPI: 1750310231
Provider Name (Legal Business Name): MICHELE DIAHANN BERGMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELE DIAHANN BRATHWAITE M.D,

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 12/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 2ND ST
BRENTWOOD CA
94513-2234
US

IV. Provider business mailing address

350 JOHN MUIR PKWY STE 140
BRENTWOOD CA
94513-5190
US

V. Phone/Fax

Practice location:
  • Phone: 925-513-2483
  • Fax: 925-513-4957
Mailing address:
  • Phone: 925-513-2483
  • Fax: 925-513-8226

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberA77659
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: