Healthcare Provider Details

I. General information

NPI: 1538479753
Provider Name (Legal Business Name): LYNN D BERGER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 07/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 PROSPECT PL STE 340B
CORONADO CA
92118
US

IV. Provider business mailing address

7801 MISSION CENTER CT STE 250
SAN DIEGO CA
92108-1314
US

V. Phone/Fax

Practice location:
  • Phone: 619-522-4000
  • Fax: 619-435-0150
Mailing address:
  • Phone: 619-738-5566
  • Fax: 619-566-0202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNP700172
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP19912
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP 19912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: