Healthcare Provider Details

I. General information

NPI: 1962334227
Provider Name (Legal Business Name): S NICOL BERGERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 WASHINGTON AVE
SAN JACINTO CA
92583-6074
US

IV. Provider business mailing address

1703 WASHINGTON AVE
SAN JACINTO CA
92583-6074
US

V. Phone/Fax

Practice location:
  • Phone: 323-528-5000
  • Fax: 951-282-2010
Mailing address:
  • Phone: 323-528-5000
  • Fax: 951-282-2010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: