Provider Demographics
NPI:1972221919
Name:BERGERON, DAUNE DENISE
Entity type:Individual
Prefix:
First Name:DAUNE
Middle Name:DENISE
Last Name:BERGERON
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 1:23796 VIA MADRID
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4542
Mailing Address - Country:US
Mailing Address - Phone:619-548-2009
Mailing Address - Fax:
Practice Address - Street 1:12329 CREEKVIEW DR UNIT 37
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-6624
Practice Address - Country:US
Practice Address - Phone:661-378-2789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD10506291OtherDRIVER LICENSE