| Dwight A Bergquist Md Inc | |
|
5230 N. Clark Avenue Suite 10 Lakewood CA 90712-2649 | |
| (562) 804-4428 | |
| (562) 867-5264 |
| Full Name | Dwight A Bergquist Md Inc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 5230 N. Clark Avenue, Lakewood, California |
| Authorized Official Name and Position | Dwight A Bergquist (CEO) |
| Authorized Official Contact | 5628044428 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dwight A Bergquist Md Inc 5230 N. Clark Avenue Suite 10 Lakewood CA 90712-2649 Ph: (562) 804-4428 | Dwight A Bergquist Md Inc 5230 N. Clark Avenue Suite 10 Lakewood CA 90712-2649 Ph: (562) 804-4428 |
| NPI Number | 1003110495 |
|---|---|
| Provider Enumeration Date | 12/29/2010 |
| Last Update Date | 06/04/2013 |
| Medicare PECOS PAC ID | 3173703972 |
|---|---|
| Medicare Enrollment ID | O20110211000123 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003110495 | NPI | - | NPPES |
| 1053407544 | Other | CA | TYPE 1 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | G38711 (California) | Primary |
| Provider Name | Dwight A Bergquist |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1053407544 PECOS PAC ID: 1456455674 Enrollment ID: I20110211000278 |
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