Healthcare Provider Details

I. General information

NPI: 1003378472
Provider Name (Legal Business Name): JILLIAN BERGER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41769 ENTERPRISE CIR N STE A101
TEMECULA CA
92590-5626
US

IV. Provider business mailing address

41769 ENTERPRISE CIR N STE A101
TEMECULA CA
92590-5626
US

V. Phone/Fax

Practice location:
  • Phone: 951-719-3738
  • Fax:
Mailing address:
  • Phone: 951-719-3738
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-22-59736
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-19-83272
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: