Healthcare Provider Details

I. General information

NPI: 1376172163
Provider Name (Legal Business Name): DYLAN GREGORY BERTONI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2020
Last Update Date: 06/01/2025
Certification Date: 06/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 NORFOLK ST STE 5800
LOS ANGELES CA
90033-1023
US

IV. Provider business mailing address

925 CHESTNUT ST FL 6
PHILADELPHIA PA
19107-4204
US

V. Phone/Fax

Practice location:
  • Phone: 323-409-7316
  • Fax:
Mailing address:
  • Phone: 215-955-6784
  • Fax: 215-955-2519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberA200669
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: