Provider Demographics
NPI:1639177520
Name:WHITTIER PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:WHITTIER PRIMARY CARE PHYSICIANS MEDICAL GROUP INC
Other - Org Name:BERGMAN MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSARIO
Authorized Official - Middle Name:LIM
Authorized Official - Last Name:CECILIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-228-3073
Mailing Address - Street 1:15111 WHITTIER BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2136
Mailing Address - Country:US
Mailing Address - Phone:562-945-6440
Mailing Address - Fax:562-945-9121
Practice Address - Street 1:15111 WHITTIER BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2136
Practice Address - Country:US
Practice Address - Phone:562-945-6440
Practice Address - Fax:562-945-9121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40764208D00000X
CAA48517208D00000X
CAA16292208D00000X
CAA46551208D00000X
CA20A3703208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty