MEDICARE: BERGEN GRACE TURNBULL

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1659039162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BERGEN GRACE TURNBULL

Provider Business Mailing Address
First Line	:	295 89TH ST STE 306
Second Line	:
City	:	DALY CITY
State	:	CA
Zip	:	94015-1656
Country	:	US
Telephone Number	:	877-264-6747
Fax Number	:

Provider Business Practice Location Address
First Line	:	2204 S EL CAMINO REAL STE 220
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6389
Country	:	US
Telephone Number	:	877-264-6747
Fax Number	:

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

Provider Enumeration Date	:	12/01/2021
Last Update Date	:	12/01/2021

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Directions to “ BERGEN GRACE TURNBULL ” Practice Location

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