Healthcare Provider Details

I. General information

NPI: 1851356398
Provider Name (Legal Business Name): AUGUSTO CESAR VICTORIANO BERTIZ JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2006
Last Update Date: 11/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3551 Q ST SUITE 100
BAKERSFIELD CA
93301-1657
US

IV. Provider business mailing address

3551 Q ST SUITE 100
BAKERSFIELD CA
93301-1657
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-3747
  • Fax: 661-616-3237
Mailing address:
  • Phone: 661-327-3747
  • Fax: 661-616-3237

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberMD426963
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA96510
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberA96510
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA96510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: