Provider Demographics
NPI:1619434842
Name:BERTRAND, RONI JR
Entity Type:Individual
Prefix:MR
First Name:RONI
Middle Name:
Last Name:BERTRAND
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 PINE CIR
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4294
Mailing Address - Country:US
Mailing Address - Phone:347-791-1757
Mailing Address - Fax:
Practice Address - Street 1:202 PINE CIR
Practice Address - Street 2:
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-4294
Practice Address - Country:US
Practice Address - Phone:347-791-1757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-24
Last Update Date:2019-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other