Provider Demographics
NPI:1114970316
Name:BERTRAN, NITZA M (DOCTORATE)
Entity Type:Individual
Prefix:DR
First Name:NITZA
Middle Name:M
Last Name:BERTRAN
Suffix:
Gender:F
Credentials:DOCTORATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:COND. TIFFANY APT. 704
Mailing Address - Street 2:4939 AVE. ISLA VERDE
Mailing Address - City:CAROLINA
Mailing Address - State:PR
Mailing Address - Zip Code:00979-5406
Mailing Address - Country:US
Mailing Address - Phone:787-726-4677
Mailing Address - Fax:787-887-5577
Practice Address - Street 1:CARR. #3 KM. 25.7 SECTOR JUAN GONZALEZ
Practice Address - Street 2:
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-18
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR11137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist