Healthcare Provider Details

I. General information

NPI: 1710089313
Provider Name (Legal Business Name): BERTHA GEE-LEW MD FAAP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2850 6TH AVE
SAN DIEGO CA
92103-6308
US

IV. Provider business mailing address

2850 6TH AVE
SAN DIEGO CA
92103-6308
US

V. Phone/Fax

Practice location:
  • Phone: 619-295-3911
  • Fax: 619-295-4356
Mailing address:
  • Phone: 619-295-3911
  • Fax: 619-295-4356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38238
License Number StateCA

VIII. Authorized Official

Name: BERTHA MEI GEE-LEW
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: M.D.
Phone: 619-295-3911