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Karl William Bergenstal

Psychologist

Behavioral Health & Social Service Providers

1601 Carmen Dr, Suite 111, Camarillo, CA 93010-3105

PECOS Enrollment

This provider is enrolled in PECOS as KARL BERGENSTAL.

Based on the most recent information from CMS, provider Karl William Bergenstal is legally eligible to order and refer claims for Part B and DME services only.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records yesterday at 10:41 AM.

Profile Details

Provider ID
1043224850
Provider Type
Individual
Full Name
Bergenstal, Karl William
Title
Dr.
Credential
PH.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
7/28/2006
Last Updated
7/8/2007

Contact Information

Practice Location

1601 Carmen Dr, Suite 111, Camarillo, CA 93010-3105

(805) 987-7006

Unlisted Fax

Mailing Location

1601 Carmen Dr, Suite 111, Camarillo, CA 93010-3105

(805) 987-7006

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 103TC0700X Primary	Description Psychologist Behavioral Health & Social Service Providers	License PSY7950 California

Karl William Bergenstal

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

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Grahm, John L.

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