Provider Demographics
NPI:1851356398
Name:BERTIZ, AUGUSTO CESAR VICTORIANO JR (MD)
Entity Type:Individual
Prefix:
First Name:AUGUSTO
Middle Name:CESAR VICTORIANO
Last Name:BERTIZ
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3551 Q ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1657
Mailing Address - Country:US
Mailing Address - Phone:661-327-3747
Mailing Address - Fax:661-616-3237
Practice Address - Street 1:3551 Q ST
Practice Address - Street 2:SUITE 100
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1657
Practice Address - Country:US
Practice Address - Phone:661-327-3747
Practice Address - Fax:661-616-3237
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAMD426963207QG0300X
CAA96510207Q00000X, 207RG0300X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA093410Medicare ID - Type Unspecified