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General NPI Number Information
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NPI Number | 1336352939
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Entity Type | Individual
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Provider Name | MARY EILEEN BERG NP
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Gender | Female
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 11/08/2010
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Provider Practice Location Address
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Address Line | 600 N MOUNTAIN AVE SUITE A104
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City | UPLAND
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State | CA
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Zip | 91786-4359
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Country | US
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Telephone | 909-931-1033
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Fax | 909-981-8976
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Provider Business Mailing Address
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Address Line | 536 E MARIPOSA ST
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City | UPLAND
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State | CA
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Zip | 91784-2071
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Country | US
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Telephone | 909-931-1033
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Fax | 909-981-8976
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 389253
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License Number State | CA
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