Provider Demographics
NPI:1073039533
Name:BERG, AMY LORRITA (CPM, LM)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:LORRITA
Last Name:BERG
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 461014
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-1014
Mailing Address - Country:US
Mailing Address - Phone:760-390-0009
Mailing Address - Fax:
Practice Address - Street 1:910 ASTER ST
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92027-1648
Practice Address - Country:US
Practice Address - Phone:760-390-0009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-16
Last Update Date:2017-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALM494175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175M00000XOther Service ProvidersMidwife, Lay