Provider Demographics
NPI:1003997032
Name:BERGANZA, JOSE DALIO (MD)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:DALIO
Last Name:BERGANZA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:14514 RAMONA BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-3305
Mailing Address - Country:US
Mailing Address - Phone:626-337-0424
Mailing Address - Fax:626-813-9095
Practice Address - Street 1:14514 RAMONA BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:BALDWIN PARK
Practice Address - State:CA
Practice Address - Zip Code:91706-3305
Practice Address - Country:US
Practice Address - Phone:626-337-0424
Practice Address - Fax:626-813-9095
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA45608208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics