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General NPI Number Information
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NPI Number | 1881574473
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Entity Type | Individual
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Provider Name | MARK BERGAMI
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Gender | Male
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Dates
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Enumeration Date | 09/04/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 8701 ANZIO ST # 8701A
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City | FORT IRWIN
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State | CA
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Zip | 92310-2456
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Country | US
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Telephone | 631-747-5382
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Fax |
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Provider Business Mailing Address
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Address Line | 8701 ANZIO ST # 8701A
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City | FORT IRWIN
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State | CA
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Zip | 92310-2456
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Country | US
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Telephone |
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 39583
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License Number State | TN
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