Healthcare Provider Details

I. General information

NPI: 1922471291
Provider Name (Legal Business Name): CAITLIN BERTELSEN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2015
Last Update Date: 06/28/2023
Certification Date: 09/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 E WARDLOW RD
LONG BEACH CA
90807-4507
US

IV. Provider business mailing address

433 E WARDLOW RD
LONG BEACH CA
90807-4507
US

V. Phone/Fax

Practice location:
  • Phone: 562-427-0550
  • Fax: 562-988-8899
Mailing address:
  • Phone: 562-427-0550
  • Fax: 562-988-8899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA138856
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: