Healthcare Provider Details

I. General information

NPI: 1992177935
Provider Name (Legal Business Name): CHELSEA BERGERON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/29/2015
Last Update Date: 03/14/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 LOMAS SANTA FE DR
SOLANA BEACH CA
92075-1412
US

IV. Provider business mailing address

8260 MIRA MESA BLVD
SAN DIEGO CA
92126-2662
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-6697
  • Fax: 858-755-7438
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: