Provider Demographics
NPI:1801926654
Name:BERGONIA, CATHERINE MAGALONG (RN)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:MAGALONG
Last Name:BERGONIA
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:CATHERINE
Other - Middle Name:MAGALONG
Other - Last Name:BERGONIA-BENNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:101 BODIN CIR
Mailing Address - Street 2:BLDG 777
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1809
Mailing Address - Country:US
Mailing Address - Phone:707-437-1805
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIR
Practice Address - Street 2:BLDG 777
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94535-1809
Practice Address - Country:US
Practice Address - Phone:707-437-1805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2011-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN00140349163W00000X
CA536508163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse