Provider Demographics
NPI:1508841602
Name:BERTAKIS, KLEA D (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:KLEA
Middle Name:D
Last Name:BERTAKIS
Suffix:
Gender:F
Credentials:MD, MPH
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Other - Credentials:
Mailing Address - Street 1:4860 Y ST
Mailing Address - Street 2:ACC 2300
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-2307
Mailing Address - Country:US
Mailing Address - Phone:916-734-3167
Mailing Address - Fax:916-734-5641
Practice Address - Street 1:4860 Y ST
Practice Address - Street 2:ACC 1600
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-2307
Practice Address - Country:US
Practice Address - Phone:916-734-3630
Practice Address - Fax:916-734-5550
Is Sole Proprietor?:No
Enumeration Date:2005-12-12
Last Update Date:2011-04-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG384680207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47491Medicare UPIN