Provider Demographics
NPI:1487370789
Name:BERGTOLD, MARIANA
Entity type:Individual
Prefix:
First Name:MARIANA
Middle Name:
Last Name:BERGTOLD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3025 MISTY GLEN DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-5719
Mailing Address - Country:US
Mailing Address - Phone:707-499-5097
Mailing Address - Fax:
Practice Address - Street 1:3025 MISTY GLEN DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96001-5719
Practice Address - Country:US
Practice Address - Phone:707-499-5097
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider