Provider Demographics
NPI:1073958104
Name:BERTORELLI, CATHERINE
Entity Type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:
Last Name:BERTORELLI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21637 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-1843
Mailing Address - Country:US
Mailing Address - Phone:561-213-0629
Mailing Address - Fax:
Practice Address - Street 1:21637 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-1843
Practice Address - Country:US
Practice Address - Phone:561-213-0629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-02
Last Update Date:2013-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS26138183500000X
NY03489-1183500000X
NJ28RI01680400183500000X
CA37539183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist