Provider Demographics
NPI:1912151192
Name:SAINT-VICTOR, BERGERETTE (FNP)
Entity Type:Individual
Prefix:MISS
First Name:BERGERETTE
Middle Name:
Last Name:SAINT-VICTOR
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4344
Mailing Address - Country:US
Mailing Address - Phone:562-324-6901
Mailing Address - Fax:562-977-5715
Practice Address - Street 1:127 W 7TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4344
Practice Address - Country:US
Practice Address - Phone:562-324-6901
Practice Address - Fax:562-977-5715
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-14
Last Update Date:2015-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18076261QH0100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily