Healthcare Provider Details

I. General information

NPI: 1861464711
Provider Name (Legal Business Name): DARREN L BERGEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S MOUNT VERNON AVE #G350
COLTON CA
92324-4228
US

IV. Provider business mailing address

900 E WASHINGTON ST SUITE 200
COLTON CA
92324-7111
US

V. Phone/Fax

Practice location:
  • Phone: 909-824-2422
  • Fax: 909-824-8234
Mailing address:
  • Phone: 909-824-2422
  • Fax: 909-824-8234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA72267
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: