Provider Demographics
NPI:1265603377
Name:BERTONI, MATTEO
Entity type:Individual
Prefix:
First Name:MATTEO
Middle Name:
Last Name:BERTONI
Suffix:
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 1:355 WEBSTER ST
Mailing Address - Street 2:APT. F
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1256
Mailing Address - Country:US
Mailing Address - Phone:650-473-9842
Mailing Address - Fax:
Practice Address - Street 1:2808 MALLARD LN
Practice Address - Street 2:SUITE A
Practice Address - City:PLACERVILLE
Practice Address - State:CA
Practice Address - Zip Code:95667-8770
Practice Address - Country:US
Practice Address - Phone:530-621-7584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program