Provider Demographics
NPI:1609879345
Name:VOTTERI, BERNHARD ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:BERNHARD
Middle Name:ALEXANDER
Last Name:VOTTERI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 ALAMEDA DE LAS PULGAS
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2751
Mailing Address - Country:US
Mailing Address - Phone:650-367-5640
Mailing Address - Fax:650-367-5110
Practice Address - Street 1:170 ALAMEDA DE LAS PULGAS
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94062-2751
Practice Address - Country:US
Practice Address - Phone:650-367-5640
Practice Address - Fax:650-367-5110
Is Sole Proprietor?:No
Enumeration Date:2005-05-25
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA21753174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA22757Medicare UPIN