Healthcare Provider Details

I. General information

NPI: 1538260583
Provider Name (Legal Business Name): WILLIAM EZIAL BERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 MEDICAL CENTER RD SUITE 244
MISSION VIEJO CA
92691-6410
US

IV. Provider business mailing address

27800 MEDICAL CENTER RD SUITE 244
MISSION VIEJO CA
92691-6410
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2900
  • Fax: 949-365-0117
Mailing address:
  • Phone: 949-364-2900
  • Fax: 949-365-0117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberC35918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: