Provider Demographics
NPI:1013192889
Name:BERTHEAU, DANIEL PETER (ANP-BC)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:PETER
Last Name:BERTHEAU
Suffix:
Gender:M
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244A GUERRERO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2302
Mailing Address - Country:US
Mailing Address - Phone:415-863-5235
Mailing Address - Fax:
Practice Address - Street 1:244A GUERRERO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2302
Practice Address - Country:US
Practice Address - Phone:415-863-5235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17146363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health