Provider Demographics
NPI:1548929862
Name:BERGIN, KEARA LORAINE
Entity type:Individual
Prefix:
First Name:KEARA
Middle Name:LORAINE
Last Name:BERGIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 LYON RDG
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-5279
Mailing Address - Country:US
Mailing Address - Phone:949-525-0952
Mailing Address - Fax:
Practice Address - Street 1:3501 JAMBOREE RD STE 1100
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2956
Practice Address - Country:US
Practice Address - Phone:949-222-1290
Practice Address - Fax:949-222-1289
Is Sole Proprietor?:No
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant