Organization
EXECUTIVE MEDICAL & SURGICAL ASSOCIATES INC.
Active
Other names
Bergey Spine Institute
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL DALENE BERGEY RN (OFFICE MANAGER)
(909) 824-2422
Entity
Organization
Contact information
Practice address
900 E WASHINGTON ST STE 300, COLTON, CA 92324-8182
(909) 824-2422
(909) 824-8234
Mailing address
81880 DOCTOR CARREON BLVD STE C212, INDIO, CA 92201-5519
(760) 775-9400
(760) 775-3000
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A72267
CA
174400000X
Specialist
A89036
CA
363A00000X
Physician Assistant
PA 52156
CA
363A00000X
Physician Assistant
PA21389
CA
Other
Enumeration date
08/22/2016
Last updated
08/22/2016
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