Provider Demographics
NPI:1073071569
Name:BERTEMATTI, JASON ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:ALEXANDER
Last Name:BERTEMATTI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8975 SW 86TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-4540
Mailing Address - Country:US
Mailing Address - Phone:305-439-9411
Mailing Address - Fax:
Practice Address - Street 1:7600 SW 87TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3635
Practice Address - Country:US
Practice Address - Phone:305-275-6770
Practice Address - Fax:305-275-6440
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9112014363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant