Healthcare Provider Details

I. General information

NPI: 1043349772
Provider Name (Legal Business Name): BRETT MICHAEL WERTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 05/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 MEDICAL CENTER RD SUITE 222
MISSION VIEJO CA
92691-6410
US

IV. Provider business mailing address

27800 MEDICAL CENTER RD SUITE 222
MISSION VIEJO CA
92691-6410
US

V. Phone/Fax

Practice location:
  • Phone: 949-276-2446
  • Fax: 949-276-2449
Mailing address:
  • Phone: 949-276-2446
  • Fax: 949-276-2449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberA90231
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: