Provider Demographics
NPI:1942253117
Name:BERGMAN, RONNI GORDON (NP)
Entity type:Individual
Prefix:MRS
First Name:RONNI
Middle Name:GORDON
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:695 SO MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106
Mailing Address - Country:US
Mailing Address - Phone:626-792-3792
Mailing Address - Fax:626-577-5206
Practice Address - Street 1:401 SO FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105
Practice Address - Country:US
Practice Address - Phone:626-795-2244
Practice Address - Fax:626-795-5480
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA206251363LP0200X
CANPF2207363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics