Provider Demographics
NPI:1831680651
Name:VAN DEN BERG, DILLON NORRIS (MS, LCGC)
Entity type:Individual
Prefix:
First Name:DILLON
Middle Name:NORRIS
Last Name:VAN DEN BERG
Suffix:
Gender:M
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27799 MEDICAL CENTER RD
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6400
Mailing Address - Country:US
Mailing Address - Phone:949-242-6909
Mailing Address - Fax:949-365-2271
Practice Address - Street 1:27799 MEDICAL CENTER RD
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6400
Practice Address - Country:US
Practice Address - Phone:949-242-6909
Practice Address - Fax:949-365-2271
Is Sole Proprietor?:No
Enumeration Date:2018-05-29
Last Update Date:2024-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS