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Individual
MIJA BERG
Active
Individual
MIJA BERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
NP479996
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
55-1915
FQHC MEDICARE PART A
CA
05
—
FHC70543G
—
CA
01
—
HAP70543G
FPACT
CA
01
—
ZZZ23222Z
FQHC MEDICARE PART B
CA
Enumeration date
10/04/2006
Last updated
12/13/2007
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