Provider Demographics
NPI:1942285820
Name:BERTINO, GUADALUPE MONTESA (MPT)
Entity Type:Individual
Prefix:
First Name:GUADALUPE
Middle Name:MONTESA
Last Name:BERTINO
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 CORTE FAVOR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2181
Mailing Address - Country:US
Mailing Address - Phone:858-353-0259
Mailing Address - Fax:760-438-8710
Practice Address - Street 1:7825 FAY AVE
Practice Address - Street 2:STE 160
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4252
Practice Address - Country:US
Practice Address - Phone:858-353-0259
Practice Address - Fax:760-438-8710
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-13
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT26354225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT26354AMedicare ID - Type Unspecified