Healthcare Provider Details

I. General information

NPI: 1023230802
Provider Name (Legal Business Name): CHRYSTAL SUMMER ROSE BERG D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 BANNOCK ST MC 0188
DENVER CO
80204-4507
US

IV. Provider business mailing address

1010 N COUNTRY CLUB DR
MESA AZ
85201-3309
US

V. Phone/Fax

Practice location:
  • Phone: 303-436-6131
  • Fax: 303-436-6572
Mailing address:
  • Phone: 480-461-2409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPOD-663
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: