Healthcare Provider Details

I. General information

NPI: 1750183323
Provider Name (Legal Business Name): BRETT BERGMANN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4730 PALM AVE STE 206B
LA MESA CA
91941-5244
US

IV. Provider business mailing address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

V. Phone/Fax

Practice location:
  • Phone: 619-900-4441
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number34843
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: