Provider Demographics
NPI:1033323183
Name:BERTOTTI, LISA (RN-NP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BERTOTTI
Suffix:
Gender:F
Credentials:RN-NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2586 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-1025
Mailing Address - Country:US
Mailing Address - Phone:760-434-2570
Mailing Address - Fax:
Practice Address - Street 1:2605 CARLSBAD BLVD
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-2208
Practice Address - Country:US
Practice Address - Phone:760-547-5215
Practice Address - Fax:760-720-2349
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA458124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily