Provider Demographics
NPI:1396886941
Name:BERTAO, TERESA IRMA (FNP)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:IRMA
Last Name:BERTAO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12360 FIRESTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-4324
Mailing Address - Country:US
Mailing Address - Phone:323-201-4516
Mailing Address - Fax:
Practice Address - Street 1:6912 AJAX AVE
Practice Address - Street 2:
Practice Address - City:BELL GARDENS
Practice Address - State:CA
Practice Address - Zip Code:90201-4057
Practice Address - Country:US
Practice Address - Phone:323-562-5813
Practice Address - Fax:323-326-1146
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA416803363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0095862OtherMEDI-CAL GROUP NUMBER