Provider Demographics
NPI:1073657276
Name:SESTEAGA, BERTHA GONZALES (BACHELORS DEGREE)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:GONZALES
Last Name:SESTEAGA
Suffix:
Gender:F
Credentials:BACHELORS DEGREE
Other - Prefix:MRS
Other - First Name:BERTHA
Other - Middle Name:NAVARRO
Other - Last Name:SESTEAGA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BACHELORS DEGREE
Mailing Address - Street 1:2307 W HORSESHOE PL
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85745-1396
Mailing Address - Country:US
Mailing Address - Phone:520-622-2597
Mailing Address - Fax:
Practice Address - Street 1:1000 S GREASEWOOD RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85745-2571
Practice Address - Country:US
Practice Address - Phone:520-225-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZSLP0717235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ576605Medicaid