Healthcare Provider Details

I. General information

NPI: 1235207143
Provider Name (Legal Business Name): MEAGHAN MORIAH BERGLUND PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEAGHAN MORIAH BAACKE PA

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 01/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4990 ROCKLIN RD #100
ROCKLIN CA
95677-4315
US

IV. Provider business mailing address

4990 ROCKLIN RD #100
ROCKLIN CA
95677-4315
US

V. Phone/Fax

Practice location:
  • Phone: 916-788-4484
  • Fax: 916-218-6252
Mailing address:
  • Phone: 916-788-4484
  • Fax: 916-218-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: