Healthcare Provider Details

I. General information

NPI: 1417929696
Provider Name (Legal Business Name): LARS F BERGLUND MD PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4150 V ST SUITE G400
SACRAMENTO CA
95817-1460
US

IV. Provider business mailing address

2604 ROCKWELL DR
DAVIS CA
95616-7664
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-9120
  • Fax: 916-703-9124
Mailing address:
  • Phone: 916-703-9120
  • Fax: 916-703-9124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberF005002
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: