Organization
EXECUTIVE MEDICAL & SURGICAL ASSOC. INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARREN L BERGEY M.D. (PRESIDENT)
(909) 824-2422
Entity
Organization
Contact information
Practice address
900 E WASHINGTON ST STE 200, COLTON, CA 92324-4192
(909) 824-2422
(909) 824-8234
Mailing address
1040 S. MT. VERNON AVE., #G350, COLTON, CA 92324
(909) 824-2422
(909) 824-8234
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
A72267
CA
Other
Enumeration date
08/10/2006
Last updated
08/22/2020
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