Provider Demographics
NPI:1982763827
Name:BORTOLUZZI, RENATO GLOSFORCE (DMD)
Entity Type:Individual
Prefix:DR
First Name:RENATO
Middle Name:GLOSFORCE
Last Name:BORTOLUZZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16471 BERNARDO CENTER DR
Mailing Address - Street 2:SUITE 200A
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128
Mailing Address - Country:US
Mailing Address - Phone:858-673-9200
Mailing Address - Fax:858-673-4201
Practice Address - Street 1:16471 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 200A
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128
Practice Address - Country:US
Practice Address - Phone:858-673-9200
Practice Address - Fax:858-673-4201
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40414122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist