Provider Demographics
NPI:1558584722
Name:TESTER, BRIDGET SUSAN (DPM)
Entity Type:Individual
Prefix:
First Name:BRIDGET
Middle Name:SUSAN
Last Name:TESTER
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV0510213E00000X
CAE4278213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWE4278CMedicare ID - Type Unspecified
CAU84275Medicare UPIN