Healthcare Provider Details

I. General information

NPI: 1073287207
Provider Name (Legal Business Name): JOSEPH RYAN BERTAO AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/02/2021
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S K ST
TULARE CA
93274-5416
US

IV. Provider business mailing address

327 S K ST
TULARE CA
93274-5416
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2043
  • Fax: 559-688-1304
Mailing address:
  • Phone: 559-688-2043
  • Fax: 559-688-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number127087
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: