Healthcare Provider Details

I. General information

NPI: 1942488085
Provider Name (Legal Business Name): KEL M BERGMANN C.P.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1319 W CARSON ST
TORRANCE CA
90501-3909
US

IV. Provider business mailing address

7720 CARDINAL CT
SAN DIEGO CA
92123-3333
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-5777
  • Fax: 310-320-6341
Mailing address:
  • Phone: 858-292-7449
  • Fax: 858-292-5496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: