Healthcare Provider Details

I. General information

NPI: 1861629453
Provider Name (Legal Business Name): LINDSEY JANE BERGREN PIERCE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2009
Last Update Date: 08/16/2024
Certification Date: 08/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 SAMARITAN DR STE 203
SAN JOSE CA
95124-3910
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 650-404-8445
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberA135090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: