Organization
BRYAN L. BERGHOUT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRYAN LEONARD BERGHOUT D.P.M. (OWNER)
(949) 433-5262
Entity
Organization
Contact information
Practice address
629 CAMINO DE LOS MARES STE 207, SAN CLEMENTE, CA 92673-2832
(949) 433-5262
(425) 225-5458
Mailing address
3600 158TH PL SE, BOTHELL, WA 98012-4750
(949) 433-5262
(425) 225-5458
Taxonomy
Speciality
Code
Description
License number
State
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4205
CA
Other
Enumeration date
12/19/2006
Last updated
08/22/2020
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