Provider Demographics
NPI:1003558859
Name:BERG, NATHANIEL KARL
Entity Type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:KARL
Last Name:BERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:663 VIA LA CUESTA
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1018
Mailing Address - Country:US
Mailing Address - Phone:619-952-9709
Mailing Address - Fax:
Practice Address - Street 1:719 THOMPSON LN STE 20400
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37204-4600
Practice Address - Country:US
Practice Address - Phone:615-875-5568
Practice Address - Fax:615-322-4466
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-12
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program