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General NPI Number Information
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NPI Number | 1366954349
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Entity Type | Individual
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Provider Name | DANIEL BERGHOLZ MD
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Gender | Male
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Dates
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Enumeration Date | 10/30/2017
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Last Update Date | 03/23/2023
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Provider Practice Location Address
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Address Line | 757 WESTWOOD PLZ
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City | LOS ANGELES
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State | CA
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Zip | 90095-7882
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Country | US
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Telephone | 310-825-7375
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Fax |
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Provider Business Mailing Address
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Address Line | 3280 15TH AVE SW
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City | NAPLES
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State | FL
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Zip | 34117-5348
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Country | US
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Telephone | 630-297-6798
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Fax |
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | RBT-17-42553
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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