MEDICARE: KYLE BERGANTZ PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant
2	363A00000X	Physician Assistant	61193	CA

General Provider Information

NPI Number	:	1609517937
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLE BERGANTZ PA

Provider Business Mailing Address
First Line	:	4500 12TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-1437
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4500 12TH AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95820-1437
Country	:	US
Telephone Number	:	805-748-4387
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/01/2022
Last Update Date	:	06/06/2022

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Directions to “ KYLE BERGANTZ PA” Practice Location

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