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General NPI Number Information
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NPI Number | 1710767447
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Entity Type | Individual
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Provider Name | BRIAN ALEXANDER BERG PMHNP
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Gender | Male
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Dates
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Enumeration Date | 10/02/2023
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 1000 EUCLID AVE
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3856
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Country | US
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Telephone | 619-515-2399
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Fax |
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Provider Business Mailing Address
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Address Line | 823 GATEWAY CENTER WAY
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City | SAN DIEGO
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State | CA
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Zip | 92102-4541
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Country | US
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Telephone | 619-515-2300
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Fax | 619-269-0199
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 95030701
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License Number State | CA
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