Provider Demographics
NPI:1235141706
Name:BERGMAN, GAYLA
Entity Type:Individual
Prefix:MRS
First Name:GAYLA
Middle Name:
Last Name:BERGMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GAYLA
Other - Middle Name:
Other - Last Name:BERGMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RNFA
Mailing Address - Street 1:4979 LOMA AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPLE CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91780-3019
Mailing Address - Country:US
Mailing Address - Phone:626-285-4095
Mailing Address - Fax:
Practice Address - Street 1:4979 LOMA AVE
Practice Address - Street 2:
Practice Address - City:TEMPLE CITY
Practice Address - State:CA
Practice Address - Zip Code:91780-3019
Practice Address - Country:US
Practice Address - Phone:626-285-4095
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA288698364SP2800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative