Provider Demographics
NPI:1205045283
Name:BRIDGET S TESTER DPM INC
Entity Type:Organization
Organization Name:BRIDGET S TESTER DPM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:TESTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:562-260-3535
Mailing Address - Street 1:3164 BOXWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-6387
Mailing Address - Country:US
Mailing Address - Phone:562-260-3535
Mailing Address - Fax:805-418-7090
Practice Address - Street 1:3164 BOXWOOD CIR
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-6387
Practice Address - Country:US
Practice Address - Phone:562-260-3535
Practice Address - Fax:805-418-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2021-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4278213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19558Medicare ID - Type UnspecifiedGROUP ID