Most Relevant Information
Provider Data
| NPI Number: | 1003232331 |
| Provider Name: | NATHAN JACOB VANDEN BERGE |
| Entity Type: | Individual |
| Taxonomy Code: | 390200000X |
| Specialty: | Student in an Organized Health Care Education/Training Program |
| License Number: |
Most Important Dates
| Enumeration Date: | 03/11/2014 |
| Last Updated: | 10/30/2024 |
Provider Practice Location
2315 STOCKTON BLVD
SACRAMENTO
CA
958172201
Practice Location Phone/Fax
| Phone: | 9167348570 |
| Fax: | 9167347950 |
Provider Mailing Location
2315 STOCKTON BLVD
SACRAMENTO
CA
958172201
Provider Mailing Phone/Fax
| Phone: | 9167348570 |
| Fax: | 9167347950 |