Provider Demographics
NPI:1033541750
Name:BERTOLINO, JAMES VINCENT (LAC)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:VINCENT
Last Name:BERTOLINO
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:99 S CHESTER AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-5804
Mailing Address - Country:US
Mailing Address - Phone:626-457-0535
Mailing Address - Fax:
Practice Address - Street 1:99 S CHESTER AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-5804
Practice Address - Country:US
Practice Address - Phone:626-497-0535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15335171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist