Healthcare Provider Details

I. General information

NPI: 1396886941
Provider Name (Legal Business Name): TERESA IRMA BERTAO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 11/05/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6912 AJAX AVE
BELL GARDENS CA
90201-4057
US

IV. Provider business mailing address

12360 FIRESTONE BLVD
NORWALK CA
90650-4324
US

V. Phone/Fax

Practice location:
  • Phone: 323-562-5813
  • Fax: 323-326-1146
Mailing address:
  • Phone: 323-201-4516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number416803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: