Healthcare Provider Details

I. General information

NPI: 1285878132
Provider Name (Legal Business Name): JASON ROBERT BERGANCIA M.A. CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2009
Last Update Date: 09/13/2025
Certification Date: 09/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27720 JEFFERSON AVE STE 120
TEMECULA CA
92590-2609
US

IV. Provider business mailing address

27720 JEFFERSON AVE STE 120
TEMECULA CA
92590-2609
US

V. Phone/Fax

Practice location:
  • Phone: 619-807-4336
  • Fax: 844-332-5907
Mailing address:
  • Phone: 619-807-4336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP16225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: