Organization
DWIGHT A BERGQUIST MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DWIGHT A BERGQUIST M.D. (CEO)
(562) 804-4428
Entity
Organization
Contact information
Practice address
5230 N. CLARK AVENUE, SUITE 10, LAKEWOOD, CA 90712-2649
(562) 804-4428
(562) 867-5264
Mailing address
5230 N. CLARK AVENUE, SUITE 10, LAKEWOOD, CA 90712-2649
(562) 804-4428
(562) 867-5264
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
G38711
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1053407544
TYPE 1 NPI
CA
Enumeration date
12/29/2010
Last updated
06/04/2013
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