Provider Demographics
NPI:1144274531
Name:BERGERON, ERIN FRANCES (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:FRANCES
Last Name:BERGERON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:FRANCES
Other - Last Name:DEMAIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2705 LOMA VISTA RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-1581
Mailing Address - Country:US
Mailing Address - Phone:805-667-2801
Mailing Address - Fax:805-667-2865
Practice Address - Street 1:2921 SAVIERS RD
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93033
Practice Address - Country:US
Practice Address - Phone:805-487-5588
Practice Address - Fax:805-487-5589
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83498207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA951683892OtherOTHER INSURANCE
CAZZT40394FMedicaid
CA050394OtherBLUE CROSS
CARHM18553HMedicaid
CARHM08609FMedicaid
CARHM08608FMedicaid
CARHM08608FMedicaid
CA058608Medicare ID - Type UnspecifiedRH MEDICARE
CARHM18553HMedicaid
I00056Medicare UPIN
CAWA83498CMedicare ID - Type UnspecifiedPPIN
CA951683892OtherOTHER INSURANCE
CA050394OtherBLUE CROSS
CA058553Medicare ID - Type UnspecifiedRH MEDICARE
CAZZT40394FMedicaid