Healthcare Provider Details

I. General information

NPI: 1417234360
Provider Name (Legal Business Name): TERRI DENISE BERGER CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TERRI DENISE DAVIS-MENDOZA CPNP

II. Dates (important events)

Enumeration Date: 11/07/2011
Last Update Date: 02/23/2022
Certification Date: 02/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 PELANDALE AVE
MODESTO CA
95356-9781
US

IV. Provider business mailing address

3525 PELANDALE AVE
MODESTO CA
95356-9781
US

V. Phone/Fax

Practice location:
  • Phone: 559-572-3880
  • Fax: 559-572-3349
Mailing address:
  • Phone: 559-572-3880
  • Fax: 559-572-3349

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberLIC#438822CERT#11720
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11720
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: