1275784324 NPI number — FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.

Table of content: DR. KARIN KAY BERGMAN M.D. (NPI 1386646594)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275784324 NPI number — FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY URGENT CARE & INDUSTRIAL MEDICAL CLINIC, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275784324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16661 VENTURA BLVD.
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
ENCINO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91436-1902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-808-2828
Provider Business Mailing Address Fax Number:
818-788-0386

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16661 VENTURA BLVD.
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
ENCINO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91436-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-808-2828
Provider Business Practice Location Address Fax Number:
818-788-0386
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FISHMAN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PRESIDENT/MEDICAL DIRECTOR
Authorized Official Telephone Number:
818-808-2828

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X , with the licence number: FNP24261 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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